[Question #355] Completely confused

35 months ago
Hello Doctors, thank you for your time in advance. I'd hate to return to this site again, but my doctor isn't very much help and I trust your guys' thorough opinion. 

In june of this year I had a pap and it came back with ASCUS, but no HPV was detected. I had a routine follow up two weeks ago, but this time I had a new doctor. She explained to me that I could be becoming infected with HPV, which would explain my ASCUS result. She said that it could take up to 1-2 years for HPV to show up on a pap. As you can imagine, this scared me to death. My repeat pap results were the same- ASCUS, but no HPV was detected. I should also mention I have not had sex in a year and a half. My doctor emailed me my results and barely explained what they meant. She states "ASCUS stands for atypical squamous cells of undetermined significance. The pathologist does not see anything that looks truely abnormal but there is some variation to the cells structure. When this happens, a screening for high risk strains of human papilloma virus is ran. This test was negative for you which is a normal result". This was all she stated. Now, i couldn't be more confused. I don't know whether to be worried or not. My questions are..

Could I be becoming infected with HPV?
Would HPV have shown up by now after two negative results?
What could be causing my ASCUS result?
Is this the beginning of cervical cancer?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Welcome back. But I'm sorry to hear you remain so concerned about something so unimportant!

I haven't read all the comments in your previous threads in detail, so forgive me if my opening comments repeat what you have already been told. But even if they do, it seems you should hear them again. Specifically:  You probably don't have HPV at this time. But so what if you DO have HIV? Getting genital HPV is a normal, expected consequence of being sexual. You probably have had genital HPV, may or may not have it now, and can expect to have future infections -- assuming, of course, that you have had anything like a normal sex life and expect to have sex in the future. Fortunately, serious outcomes are rare, and most can be prevented by vaccination and by following routine advice about pap smears.

Try this:  next time you're among other people, glance the next 100 women age 15-40 who you see. Then contemplate that at least 90 of them have had or will have HPV; 30-50 of them are actively infected at this time; it will eventually clear up in almost all of them whether or not they are treated; none of them will die of it; and the few who actually have diagnosed infection or disease will have it cured before it causes serious problems.

With that as a start, now going to your specific questions:

1) ASCUS means exactly what your doctor said, with emphasis on "undetermined significance". It is not known to be due to HPV. There is no reason to suppose it means you have HPV or are "becoming infected" with it.

2) Probably yes. The HPV tests aren't perfect, but if you had an active infection at this time, I would have expected one or both tests to be positive.

3) The causes of ASCUS are unknown. I cannot speculate on it and neither can anyone else.

4) For sure this is not "the beginning of cervical cancer". ASCUS has nothing to do with cancer and does not raise the risk of future cancer.

I hope these comments will help you finally put all this to rest. Best wishes and happy holidays--

HHH, MD
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
In paragraph 2, obviously "But so what if you DO have HIV?" should say HPV, not HIV. Foregive the typo.

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35 months ago
Thank you so much for the clarification. The previous doctor that answered my question on this forum had the same outlook as you- he did not believe I had HPV, and did not think I had anything to worry about.

I hope i'm understanding you correctly; 
Ascus is not known to be caused by HPV, is that correct?
Also, I am not infected with HPV, correct?
Lastly, do you believe I am becoming infected with HPV or is my doctor misinformed about this?

Sorry for all the questions, i'm new to this. I'm 21 and this is only my second pap smear, so I have no idea what any of this means. I'm not exactly sure what squamous cells are and what they're job is within the cervix. I'm glad you are not concerned though, which makes me feel even better. My doctor seemed to be worried about my pap, which only freaked me out more. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Thanks for the thanks. I'm glad to have helped.

Correct on all three points of understanding. I can't say your doctor is "misinformed"; it's probably more likely that she didn't communicate clearly or you misunderstood something. A person can "become infected" with HPV only at the time of sex with an infected person. You cannot become infected 18 months after being exposed. If she meant that the test can become positive over a longer period of time, that's probably true. However, if you caught HPV 18 months ago, probably it would be gone by now, cleared by the immune system -- and not still working up to a positive test result.

Having not previously known your age, my additional advice is that you be vaccinated against HPV if that hasn't been done. Vaccination is advised for everyeone, regardless of sexual lifestyle, and will prevent infection with the 9 HPV types most likely to cause cancer or warts. Do it for sure!

Beyond that, you truly should not worry another moment about HPV your recept pap. Just go on with your life -- knowing that HPV is natural part of human life.


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35 months ago
Thank you for all of your advice Dr., i sincerely appreciate it. 

A couple of last questions before I go..
I did get the Gardisil (don't know if i'm spelling it right) shot when I was 13. However, I do not recall if I got all 3. I got one before I was sexually active, and the 2nd one after I was sexually active. My boyfriend and I were both virgins though, so I do not believe there was anyway we could of transmitted HPV to each other. He was the only person I had been with when I got the shot. I do not recall if I got a 3rd shot, but am almost certain I got the 2nd. 
Is the vaccine still effective even if I only got 1 or 2 rounds of the shots?

My Doctor finally called me back and said that they did not find any abnormal cells, but ASCUS is still something to keep an eye on. She said she is not really concerned because both of my HPV results have come back negative. She said if I still have ASCUS in 6 months, then they will do a biopsy to determine the cause of it. She said ASCUS is pretty common in women. Lastly, she said that it is possible that I once had HPV and it is now coming back, but she would guess probably not given both of my negatives- 6 months apart. 
If I did acquire HPV, wold this prevent me from having kids?
Can HPV be cured?
If it goes away, will it come back?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Gynecologists are the best experts on ASCUS and your doctor probably is more up to speed on it than I am. It sounds like she is very knowledgeable and you should trust and follow her advice.

HPV never prevents having children. There is no need for cure; when you are infected someday, your immune system will clear it up. Sometimes it comes back, but usually not.

Two doses of Gardasil are almost as effective as all three doses. Therefore, you are already highly protected against any important health problem from HPV. But in addition, in the past year a new version of Gardasil has become available. The old one prevents infection with 4 types of HPV, which together cause 70% of cervical cancer and 90% of genital warts. The newer one (Gardasil-9) prevents infection with 5 more HPV types, covering over 90% of cancer-causing strains.

That completes the two follow-up comments and replies that come with your posting fee, and so ends this thread. I suggest you post no more questions about HPV on this forum. If further questions come up, first re-read all the replies on all your threads so far. You'll probably find your new questions were already answered. Also continue to speak with your own doctor; it sounds like she is very knowledgeable about HPV, pap smears, ASCUS, and so on. You can also find excellent, reliable information on the web, including ASHA's main website and the US Centers for Disease Control and Prevention (www.cdc.gov/std).

Best wishes and happy holidays.
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