[Question #4756] HPV results

25 months ago
Hi. Hope yall remember me! I was able to get my old results from 11 years ago and turns out it was mild dysplasia, and it was high risk HPV. My DR was surprised they even  tested it back then and said nowadays they would have not even treated that diagnosis. Regardless, I had the cryo done back then. My DR is almost impossible to reach because he is working on an army base now but I had questions reading through my results and thought one of you could shed light. I believe it was under my biopsy that said koilocytes atypia. I've researched the heck out of it and know it is cell changes but I also read something that said even under tissue examination, mild dysplasia can be mistaken for condyloma. I doubt they even tested for low risk along with high risk back then, so I'm trying to figure out if the koilocyte atypia is typical for high risk and make sense of my results. The site I read says, "Condylomatous lesions, although readily diagnosed on the vulva, are often missed in the vagina and on the cervix by clinical diagnosis alone. The lesions are, however, quite common and may be misdiagnosed by cytology, colposcopy and even tissue examination."  So I'm confused. It is obvious to me I will never know the exacts of this virus and that is troubling, because I have OCD and I like  having answers to everything. I don't think this has been asked before on here as i have searched. Could you shed light on my curiosities? Thank you!! My concern is I'd rather have had the high risk than warts. I know that's sad but I'm succumbing to the stigma. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
Welcome back once again. I'll try to help. Part of the problem, I think, is that many pathology reports sent to doctors -- i.e. biopsy results -- contain language intended to educate doctors who may not be familiar with the details of what the results mean or how to interpret them. They also use scientifically precise terms, often little changed from the original Latin or Greek, rather than everyday terms. Presented in less fancy terms and without educational information for your doctor, this report says you had cellular changes typical for genital warts (cells called koilocytes, or koilocytic atypia). That's all. In other words, you had cervical warts, and probably not pre-cancerous dysplasia.

Another common confusion is that biopsy results are different than pap smear results and use different terminology. That's often where warts vs dysplasia (pre-cancerous cell changes) may come into play. A pap smear may be consistent with dysplasia, but the biopsy may not confirm that. When there is a difference, the biopsy rules; it is inherently more precise.

It's interesting that these changes apparently were associated with a high risk type of HPV. However, i wonder if you have more detail on the HPV testing. Usually such reports would reveal the specific HPV type(s) found, terms like HPV16, HPV31, etc. It is slightly unusual for a high risk type to cause warts, but it can happen -- and probably more frequently on the cervix than on external genitals. And having said all that, determination of HPV types is not always 100% reliable. When more than one HPV type is present, not all types may be detected. In other words, it is conceivable that although one or more high risk HPV types were present, you might also have been infected with a low risk type like HPV6 or 11, which could have been the cause of the warts (koilocytes) found on biopsy.

In summary, I'm afraid this information doesn't do what you hoped:  even with this expanded information, it is uncertain what HPV type(s) you had. On balance there's a good chance you were infected with low risk (wart causing) HPV. Still, this really should not contribute to ongoing stigma or anxiety. With no apparent recurrence of warts or abnormal pap smear in the past 11 years, it is unlikely you have an ongoing active infection or that you will ever transmit your past HPV strain(s) to current or future sex partners. And even if that happened, probably no harm (and no visible abnormality) would ever come to them.

Finally, don't look at yourself as the Lone Ranger! Studies from Scandinavia -- where essentially all health records are public, i.e. availble for epidemiologic study -- 25-30% of all persons experience genital warts. There is every reason to believe it's just as common in the US and elsewhere. So if you indeed had a wart virus infection, you're just like at least one third of the entire US population. Being upset about this is not much different than being upset because you have freckles or pimples from time to time. You should try to look at getting HPV, and often carrying it for prolonged periods, as a normal, expected consequence of being human. Just like carrying all the other billions of normal bacteria and viruses that continually inhabit our bodies. That some of these are acquired at times of human intimacy doesn't really make them special! Most people just live with such knowledge.

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

HHH, MD
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25 months ago
Thanks for the clarification. It makes sense that I had concurrent HPV.
1. So high risk isn’t associated with koilocytes? 
2. And it was warts that wasn’t visible to the naked eye? Only visible through biopsy? 
Thank you 
25 months ago
Sorry it sent before I was done! 
3. Does this mean if it recurrs it will be in the same spot? On my cervix? 
4. How likely is recurrence? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
1. Knowing your compulsions, I chose my words carefully when I wrote "It is slightly unusual for a high risk type to cause warts, but it can happen". (And koilocytes = warts.)

2. I cannot judge whether your doctor visually saw ("naked eye") what he thought was wart tissue when he did the colposcopy and cryotherapy. Dysplasia and warts of the cervix can appear identical.

3. Almost all HPV infections are multifocal. Think of it like an iceberg:  the visible abnormality often is only a small portion of the total infection. It is very common (probably usually the case) that active HPV is also present at sites that are visually normal. Recurrences therefore can be pretty much anywhere in the genital or anal area.

4. The data on recurrence frequency are not precise. Most people do not have known recurrences, and it's probably increasingly uncommon as time passes. After 11 years, it is not likely you'll have a recurrence of your past HPV. Beyond that, I can't put a number or percentage on the likelihood. But I would judge you're more at risk for new HPV from current or future sex partners than you are from recurrence of your past infection. But it could happen. Once again, this is just like everyone else:  Over 90% of humans get genital HPV, so virtually everyone you know or meet has had it. You and they are at equal (but low) risk that symptoms or abnormal paps will recur in the future. That's life.
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25 months ago
Ok my last post! (On THIS thread, haha) 
It does make me feel more normal to read the threads and laugh at myself for worrying too much, and thanks for what y’all do. I can tell you consciously articulate for obsessive people and for that I am grateful! 
1) are the wart causing strains missed easily in a pap? ( Or missed more easily than high risk)
2) you said koilocytes = warts but since they all have the potential to cause warts, can you elaborate on that a bit? 
Thanks again! 
25 months ago
Sorry, also can warts cause cell changes? 
Sorry for the double post 
25 months ago
I should’ve waited until I had all my thought bc I forgot I wanted to ask if koilocytes can be found elsewhere because I’ve read it’s a precursor to cancer (sorry for triple post) 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
1) Yes, low risk (wart causing) HPV types are less likely to cause pap smear abnormalities. I stress "less likely", not "unlikely" -- asymptomatic (invisible) infections occur with any and all HPV types. 

2) "Koilocytes = warts" wasn't meant literally. Koilocytes are the signature cells that make up wart tissue. All HPV types probably have some potential to cause warts, but some do so much more frequently than others, which is why almost 90% of genital warts are caused by only two types (HPV6 and 11), among the 200+ types of HPV that exist.

Actually, this being your third question, I suggest it be the last on this topic. 
We discourage repeated questions on the same topic or exposure, and sometimes delete excessive ones without reply and without refund of the posting fee. I suggest this from compassion, not criticism, and to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them, especially among anxious persons or those with OCD. (There's always another "yes but", "what if", or "could I be the exception" question, right?). Finally, such questions have little educational value for other users, one of the forum's main purposes. Thanks for your understanding. 

Thanks for the thanks. I'm glad you appreciate our services. Best wishes and stay safe.
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
Your last two questions came in while I was writing the above reply. Warts don't CAUSE cell changes. They are benign tumors DUE TO certain cell changes. All HPV infections are potential cancer precursors; koilocytes primarily indicate warts, but can be precancerous -- as all warts can be. The important point is that the vast majority of HPV infections, even with the highest risk types like HPV 16 or 18, do not progress to cancer. And progression to dangerous cancer is entirely prevented by following standard pap smear guidelines. Even with your past abnormal pap, you are no more likely to have an HPV related cancer than any other female of your age -- maybe less, because you had cryotherapy.

So that will have to wind up this discussion. Take care.
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