[Question #4507] Is HPV likely to recur because of Herpes?

27 months ago
Hi, I had HPV & high grade CIN twice over the span of 7 years.  (Once in 2003 and once in 2010 - had treatment both times). I now have annual negative HPV and PAP tests. 

1. I’ve read your responses and you say HPV recurrences are unlikely. Since I had HPV / CIN two different times, with 7 yrs. in between the two, is it likely these were 2 different infections from 2 different strains? Or, was it a recurrence?

2. The last time I had HPV and CIN was 8 years ago and have tested negative for HPV ever since. Due to having had this twice in the past, I constantly worry about recurrences from the original infections. Is this likely? I’ve been in a monoous relationship for 3.5 years and have continued to test negative for HPV. I’m so worried about recurrences from the strains I already have - I don’t worry as much about new strains due to my monogomy. 

3. In my current relationship, I got Herpes 2 in the beginning of the relationship. While my outbreaks are becoming less severe, I still get frequent outbreaks - usually before my period. Does HSV 2 impact HPV? Since I’m getting outbreaks of HSV 2, will that make it more likely for my HPV to re-activate? Will the HSV 2 outbreaks ever stop or will I continue to get outbreaks for life?

4. I have a hard time understanding why HSV 2 re-activates, but once you clear HPV, it doesn’t re-activate? Why is it the HSV 2 re-activates but HPV doesn’t and how do the two viruses impact each other?

I really appreciate you taking the time to answer my questions. HPV recurrences constantly weigh on my mind due to having it twice and I worry that Herpes 2 will impact this. Thank you so much. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
27 months ago
Welcome to the forum. Thanks for your confidence in our services.

I'm afraid there's not much data on which to base replies to these questions; it's more an issue of clinical experience and estimated probabilities. But I'll do my best. 

1) Indeed, HPV recurrences are not the norm. However, they're not all that rare either. And when millions of persons are affected, some people are bound to have 2 or more episodes of active HPV disease, as you apparently have had twice. But it's not possible to know whether your second episode of CIN was a recurrence or the result of a new HPV infection, unless the type of HPV causing the problem was determined both times. Absent such testing, I would be inclined to guess the latter, i.e. two different infections with different HPV types. But if your HPV was not typed both times, it's impossible to know.

2) As just implied, most people in your situation never have a recurrence of HPV. And having had two episodes probably does not predict you're more likely to have yet another episode of CIN or other active HPV infection. I can't say it's impossible, but having gone 8 years with no problem, most likely it will never come up again.

3) I am unaware of any data to suggest either HPV or HSV influences reactivation of the other. (A few decades ago, before HPV was understood to be the cause of cervical cancer, it was suepcted that HSV2 might be the culprit, but any influence of HSV2 on cancer or precancerous pap smears is now believed to be small, if any.) Once again, absence of any problem with HPV or recurrent CIN in the 3+ years since you acquired genital herpes suggests it's not an issue for you. (Comments below about your frequent herpes outbreaks.)

4) The reasons either HSV2 or HPV reactivates, and why some people have more frequent herpes outbreaks than others, are largely unknown. While the immune system must be involved in ways not yet understood, most people with frequently recurring herpes (or HPV, for that matter) seem to have entirely normal immune systems. Further, the details of the immune system's response to HSV and HPV are quite different. As noted above, I would not suspect that having frequent herpes outbreaks means you are more likely to have a similar problem with HPV. 

All things considered, your genital herpes seems to be a more important issue in your life than HPV and your past CIN episodes. You don't mention treatment, but I hope you are aware that genital HSV2 outbreaks can be largely prevented with ongoing antiviral treatment with valacyclovir or acyclovir. If not, you should discuss it with your doctor. Both drugs are virtually without toxicity or side effects, and it sounds like such suppressive treatment might make a big difference in your life. Over time, genital HSV2 outbreaks tend to become less frequent and sometimes less severe. However, this can take many years and may not happen at all -- perhaps reinforcing consideration of suppressive treatment, assuming you're not already taking it. (If you are on such treatment already, the issues become more complex. In that case, let me know and we'll see where it leads.)

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
---
---
---
27 months ago
Hello, Dr. Hansfield -

I truly appreciate your responses. No, I’m not currently on treatment for HSV 2, but will definitely ask my Doctor about it. 

No, I didn’t have the HPV typed for the two episodes - they said it was a result of HPV but never said which type. One thing to note - when I went through the CIN episodes, it was only detected because of the PAP. Once the PAP was abnormal, then they did the reflex testing to confirm the HPV. After both episodes, I continued with PAP smears but they never did the co-testing alongside it. So, when my 2nd CIN episode occurred, again, it was only picked up by the PAP and not the HPV testing. What I’ve been wondering is if after the first CIN treatment, and since I only had PAPs and never HPV testing after the treatment, maybe there still could’ve been HPV present that eventually caused the second round of CIN? Meaning, the treatment didn’t get rid of all the HPV and that’s why I had the 2nd round of CIN? 

Now, as of 5 years ago, I ALWAYS do both the annual PAP and the annual HPV testing - so for the last 5 years, I’ve been negative for HPV.  And the last 8 years, normal PAPs. 

One thing you mentioned is that the immune system’s response to HPV and HSV seems to be quite different. Would you perhaps have more details or info you could share about that? Does this maybe explain why HPV doesn’t typically recur or reactivate but herpes does?

Sorry for all of these questions - I just feel so worried all the time, and I feel gross - I’m guessing not that many people have both HPV and HSV 2. It’s so depressing and stressful! 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
27 months ago
You misunderstand a basic fact about HPV. Visible growths (warts, pre-cancerous cervical lesions, etc) are the tip of the iceberg. HPV is much more widespread, involving surrounding and/or nearby tissues that appear entirely normal, and removing or destroying involved tissues always does not (and is not intended) to treat or cure the HPV infection itself, just the abnormal growth. And in any case, as I said above, your second CIN episode probably was caused by a new HPV infection, not recurrnence of the previous one.

Reflex testing for HPV was the norm for many years, although today it's often done simultatneously with the biopsy or Pap smear, just as with your Paps the last few years. Your wording suggests you might have another (minor) misunderstanding:  Almost every abnormal pap smear is caused by HPV, and in any particular case, testing for HPV is not necessary to know it.

HSV and HPV infect different kinds of cells, which largely determines differences in the immune response. There are other details about the roles of antibody, different classes of immune-reactive cells (macrophages, lymphocytes, and so on) that undoubtedly are quite different between the two. It's very complex, not complletely understood, and I'm not sufficiently expert in immunology or virology to say more.

Your questions and your closing comment imply you feel you have a unique and unusual problem. You do not, and it is untrue that "not many people have both HPV and HSV2". Probably nearly 100% of people with HSV2 have HPV, or have had it at some time since acquiring genital herpes. And since 15-20% of the US population has HSV2, probably about that percentage of HPV infected persons have HSV2. There must be tens of thousands of women every year, in the US alone, who develop CIN and also and also have HSV2.

---
---