[Question #3897] HPV 16

34 months ago
Hi, 
I've been with a steady monogamous partner but strayed once a few years back. It was around that time I was diagnosed with HPV 16. Initially I was worried, but when I was pregnant about a year later my OB at the time said the pregnancy was fine and my child was not at risk in utero or during vaginal delivery. I was diagnosed in 2013 but the exposure was 2012. I had totally forgotten about HPV in general. I was sexually assaulted recently and had the whole battery of tests done (minus hepatitis) as well as two Western Blots for HSV. I was negative for all tests. I am 30 now and for my yearly pap, my gyn asked if I've ever had an abnormal pap. I explained my HPV 16 diagnosis in 2013. My results came back positive for subtype 16 but normal pap (I've had normal paps since my pregnancy, about 3.5 years post diagnosis). I underwent a colposcopy at his suggestion which was normal, and was told to repeat the pap in 3 months. At the next pap, I was just coming off my period and asked if that would interfere, he said no and the results were low grade SIL.

My questions are:
1. Are all these paps necessary? I've had HPV 16 for almost 6 years now and it seems to be an issue now for some reason. 
2. Other posts have reassured me this is nothing but a nuisance, but is DNA detection for this many years normal? Am I at a higher risk for cervical cancer?
3. Would a condition like Lynch Syndrome raise my risk for any cancers due to HPV?
4. I performed unprotected oral on the guy both times we interacted. He was uncircumcised. Should I assume I have HPV orally as well? I've shared spoons and straws with my children and didn't think anything of it until the gyn put so much emphasis on this. Are the kids ok, and can I keep sharing food/drinks in this way? 
5. Would a period interfere with a pap the way it did to detect LSIL? 

Thanks! 
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Welcome to the Forum.  I'm sorry to hear of your recent assault and will try to provide helpful information.  From the sound of things your doctor is erring on the side or caution.  I'm not completely clear, do you have Lynch syndrome?  If so, it is hard to fault your doctor for being overly cautious although it really does sound like you are having a lot of examinations.  Typically, once a person has had several normal PAP smears, the frequency of testing can be reduced.   

In answer to your specific questions:
1. Are all these paps necessary? I've had HPV 16 for almost 6 years now and it seems to be an issue now for some reason. 
I'm not sure why the doctor has decided to increase your frequency of testing at this time and would suggest you ask her/him.  With normal and low grade SIL I would not normally be doing tests so frequently.

2. Other posts have reassured me this is nothing but a nuisance, but is DNA detection for this many years normal? Am I at a higher risk for cervical cancer?
Typically HPV infections become non-detectable within two years after initial detection.  If the virus continues to be detectable beyond that, there is a slight increase in risk for development of pre-cancerous lesions which could then be treated and continued regular tests are appropriate although every 3 months seem like a lot.

3. Would a condition like Lynch Syndrome raise my risk for any cancers due to HPV?
Lynch syndrome predisposes persons to development of certain cancers.  It is reasonable that this might interact with HPV to somewhat increase cancer risk and therefore warrant closer observation, just as it warrants more frequent colonoscopies and other cancer screening measures.

4. I performed unprotected oral on the guy both times we interacted. He was uncircumcised. Should I assume I have HPV orally as well? I've shared spoons and straws with my children and didn't think anything of it until the gyn put so much emphasis on this. Are the kids ok, and can I keep sharing food/drinks in this way?
No, oral HPV is far less common than genital infections.  Your risk is low.  Your children are not at risk because of shared eating utensils.  I disagree with your gyn.  That she/he warned you about sharing utensils makes me thing that she/he is being overly conservative.
 
5. Would a period interfere with a pap the way it did to detect LSIL?
No.

I hope this information is helpful.  I do not know enough about your relationship to your current care provider to be sure but I wonder whether either a discussion of these questions or a second opinion might be helpful to you.  EWH
---
34 months ago
Thank you for your response. I have not been diagnosed with Lynch syndrome but recently learned my older sister was and was curious of the possibility. She said she had BRCA testing and something else done, but I know I am not a carrier for BRCA 1 or 2.  I’m not sure if/what other tests should be done to rule it out. I’ve asked the gyn about the frequency but have only gotten the response for “more information”. After my assault it was the same gyn who dismissed my concerns about having herpes (I had a low positive IGG, which led to my WB I pursued on my own) so it strikes me as odd that he would be dismissive with that but overly cautious with HPV. 

I’ve been worried about the oral HPV from these encounters so your response is reassuring. I have given unprotected oral to 4-5 men in my adult life, does this change your opinion in any way? Average encounters were about 2x each. 

Also, would my genital infection still be infectious since it’s still detectable? My husband is likely infected by now but he doesn’t perform oral on me often. When he does, I’m worried that he would get it orally and raise his risk of oropharangeal cancer. Is this a reasonable worry?

Would the virus be spread by touching dirty laundry, or washing with the children’s clothes say if the washer is overfilled and doesn’t wash properly?

Any risk if showering with small children? Or if they climb into bed and little feet or hands brush against my vagina? I sleep only in underwear and sometimes they slide to the side and don’t cover completely. 

I have an itchy/very sensitive left labia, usually mild (only noticed if aware of genitals) but is more pronounced near my period. There is no redness or swelling, looks like normal skin but can feel tender if the pubic hair is moved at times. Is this related to HPV in any way? 

Would a menstrual cup aggravate my cervix enough to reactivate the virus? 

And any reasons why you think this is still detectable? I’m healthy otherwise, no medical conditions, never smoked, use a copper IUD for contraception and vegetarian. I also had a benign fibroma removed from my finger which worries me about cell replication and cancer risk. 
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Your risk for oral HPV is low.  Fare fewer people are infected with oral HPV than genitally, oral cancers are much less common than cervical cancers and dentists now routinely check for oral pathology when they do their regular exams.  I would not worry.

HPV is not spread through contact with dirty bed sheets, touching or casual contact of the sort you describe.  Your children are not at meaningful risk from the sorts of activities you have described. 

Your genital sensitivity is not a sign of HPV. 

there are no data on the effect of menstrual cups of HPV.  I cannot think of any reason that one might have an effect.

I have no idea why your HPV is persistent but it sounds like you are being followed for it and that is absolutely the right thing to do.  At this juncture that main thing for you to do is to work with a gyn whom you feel comfortable with to make sure you have regular (but not excessive) follow-up.  I would try not to worry about this as much as you seem to be doing.  You are doing the right things.  EWH
---
34 months ago
Thanks Dr. Hook. 
1. My question about infectiousness wasn’t addressed from above, just curious to whether the HPV was still transmissible since it is still being detected?

2. I know for sure my husband has acquired it genitally by now, but is his risk for it in the oropharyngeal region high? Again, he has performed oral sex on me but not often and not for long periods. I’d have to guess I would have it orally from the amount of times I’ve performed on him vs. him to me. 

3. Is this something I should be actively concerned about like my gyn? Initially I wasn’t and actually forgot all about it, but all the paps this year have made me anxious. (I had really bad anxiety with HSV and infectiousness toward my family after the assault and it’s taken me a long time and therapy and testing like crazy to get over it. Sometimes I immediately jump to that with the genital irritation and I would hate to go down a similar rabbit hole with HPV.)

4. Maybe this is outside the realm of the forum, but do you know which test I would use to screen for Lynch Syndrome? My sister doesn’t remember the other and her GP is recommending hysterectomy based on her BRCA test.

5. Besides less paps, do you have any other advice on how to move forward? Any ways to maybe help my immune system “clear” it so it isn’t detectable? 

I know I’m lucky considering people have life threatening illnesses but I know my guilt from the infidelity years ago coupled with my worry about how my body will handle this as I age is nagging at me. Thank you for all your time and responses!
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
 Straight to your follow-up questions. I am sorry my answers were not clearer.

1.   When the virus is detectable it is typically considered transmissible.   Similar way when the virus has been detectable for a prolonged period of time it is appropriate to follow patients more closely although as I have indicated it sounds like you are being followed very closely. 

2.   In general oral HPV infections are far less common than general infections. It is not a sure thing at all that either you nor your husband have oral HPV.   Irrespective given that you have been partners for sometime I see no reason to modify your current sexual practices. 

3.   As I said earlier, based on limited information it appears that your GYN is testing you quite frequently. I would ask him or her about the basis for this. If you are uncomfortable with him/her I would consider asking for a second opinion. 

4.   I am just not sure what the appropriate test is to diagnose Lynch syndrome. I would speak with your doctor about that.  If your doctor is unsure they can refer you to a geneticist. 

5.   The best way to follow a persisting positive HPV test/ abnormal Pap smear is to repeat Pap smear and HPV test. Resolution of persistent HPV infections may take several years.  In persons with persistent HPV however, only a minority of infections go on to progress to  pre-cancerous lesions. Pre-cancerous lesions can be treated when they have been diagnosed. If you have concerns about the path that your GYN is following my suggestion would be to go to another  GYN for a second opinion. 

 This is my third reply to your questions. I hope my comments and suggestions are helpful to you. As per forum guidelines now that you have received three replies, this thread will be closed in a few hours. I wish you the best. Take care. EWH. 
---