[Question #4619] HPV

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80 months ago
Hello. I was told i have hpv in 2007. I recently started thinking about it again and looked into it more. My doctor said since I had cryotherapy (which I guess they don't really do much anymore) that I probably had mild dysplasia or CIN 1. They didn't do type testing back then. My paps have been normal since. My question is, all these websites say the strain that causes warts can't cause cancer. But hpv is the wart virus and my doc said even high risk strains can cause cervical warts or discoloration or cancer. Types 6 and 11 can also cause cervical warts. It makes me wonder if I had warts on the inside or what. It seems contradicting. Can you clear up the "the kind that causes warts can't cause cancer" if the cancer strain can also cause warts contradiction? Also, is LSIL and/or ASCUS warts or dysplasia or what? Thank you, I can't seem to fully comprehend.
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Edward W. Hook M.D.
80 months ago
Welcome to the Forum.  I'll do my best to help.  The problem here is a matter of terminology.  Let me try to explain.

HPV- the virus can cause a lot of problems- there are over 200 different strains (different types) of HPV.  Some types are far more common than others.  Two common types- HPV types 6 and 11 cause most visible genital warts. Several other types, including HPV types 16, 18, 33 are VERY common and in a minority of cases, over time lead to abnormalities which are referred to as ASCUS, LSIL, CIN, etc. and ultimately to cancer (most infections with these types of HPV still go away without any therapy or future problems).  

If you had visible, internal warts, it is most likely that they were due to HPV 6 and 11.  Indeed, infections such with types 6 and 11 almost never progress to problems such as LSIL or, ultimately, cancer.

Does this explanation help?  I hope so.  EWH
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80 months ago
Yes this helps a bit. I don’t know if they were visible internally but I was treated with the cryotherapy for three minutes on, some thaw time, and three minutes again. I guess I’m trying to figure out what type I had based on the treatment because it was so long ago. 6 and 11 can cause abnormal paps too so I don’t even know because I wasn’t type-tested. I’ve just assumed this whole time it was the non wart causing kind. My doctor said even the high risk can cause warts, mostly flat on the cervix. That’s what had me confused. 
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Edward W. Hook M.D.
80 months ago
This sort of cryotherapy is administered for both visible warts and for HPV-related PAP smear changes.  My guess is that you will not know what sort of HPV was there and, at this point, it probably is not important.  EWH---
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80 months ago
1. It’s used for visible warts on the cervix? Because that’s where they froze.
2. What would the pap say for 6 or 11? LSIL, ASCUS, HSIL, etc. because on a past post i saw you say it CAN cause these results but in my post you say it almost never progresses to LSIL so what abnormality would a pap report for the wart strain? 
3. If I am able to get my results from back then would that help me figure out which kind even though there was no test-typing? 
4. Does LEEP and other current treatments also treat visible cervical warts? 
5. On a labcorp result it showed history of abnormalities and said 2007, LSL. (Even though the actual result wasn’t there it just had history timeline) what does LSL mean? I can’t find it anywhere saying what it stands for and I assume it’s LSIL. Although on another result it lists my history as ASCUS. I just wish I had the original result. 

Sorry, it IS important to me. I’m in a committed relationship now but if something happens what would I tell future romance interest, because I believe in full disclosure even if it’s unimportant. Do i say, “I have HPV virus and it could be either warts or cancer strain?” 
It’s just very stressful. I want to know exactly what’s in my body. 
Thank you for your answers! This is my last post so hopefully it can help my OCD. 

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80 months ago
Also (I’m sorry) is CIN and LSIL the same thing? Thanks! 
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80 months ago
And when I look at pics of “cell changes” that progress to cancer, they look raised.. like warts. This furthers my confusion. Sorry I added posts. 
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Edward W. Hook M.D.
80 months ago
I'll try to help with your follow-up questions.  BTW, this will be my final response since our Forum allows three responses to each client's questions.  I should reiterate in general terms our stance on HPV infections which may be helpful.  We consider HPV to be a widespread nuisance for most persons who get the infection.  About 80% of sexually active persons will have  had HPV (this figure is true on average even for those who have had a single lifetime partner.  In well over 95% of those persons the infections will go away over time and the proportion which will progress to cancer is less than 1 or 2% of those with the so-called high risk types.  Our standard recommendations include: 1.  Get vaccinated - the recommendations have now been expanded to cover persons up to age 45, even if they have had an HPV infection in the past; 2. There is no need to notify sexual partners if you have HPV since most people already have it and since it is virtually impossible to tell who tell who it was acquired for; and 3. Women should follow sexual health screening guidelines for screening and HPV testing to allow management of infections with the potential to progress (most of these infections would also go away by themselves but treatment sooner than later is preferable.

In answer to your most recent questions:
1. Cryo is used for both visible and not visibly apparent HPV infections (i.e. warts and PAP smear detected infections).
2.  HPV 6 or 11 can cause both ASCUS and LSIL. The proportion of these conditions with HPV 6 and 11 declines as the stages become more advanced, i.e. More in ASCUS than in LSIL and more in LSIL than in HSIL.
3.  It would probably not help to get those results of HPV typing was not done.
4.  Yes
5.  I agree LSL is probably LSIL

There is a slight difference between CIN and the SIL classifications. CIN is now out of date.  

Please see my comments about partner notification above.  In addition, I would suggest that you read some of the other posts that Dr. Handsfield and I have answered on this Forum regarding the topics of HPV and, in particular, the topic of partner notification.   This will complete this thread.   EWH 

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80 months ago
Thank you! This helps. So obviously if pap is abnormal and Hpv test is negative it’s probably due to a low risk type they don’t test for. This makes the most sense to me. Thanks again for your help and understanding. 
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Edward W. Hook M.D.
80 months ago
Correct.  Glad I could help.  closing the thread now. EWH---