[Question #4890] HPV Questions

79 months ago

When I was 20 years old I I went to see a gynecologist for abdominal pains and he decided to perform a pap smear. A few weeks later I received a phone call saying that “pre-cancerous” cells were found on my cervix and that a colposcopy was required. At this point, I do not remember there being any mention of HPV infection, only Cin-1. There was no talk of disclosure to past, current, or future partners. I received my colposcopy in November of 2016, a month after my initial pap smear, and this colposcopy came back positive for LSIL/Cin-1. My doctor requested I return in 3 months for another pap smear. I received another pap smear in February of 2017 which also came back positive for LSIL. He requested I return in 4 months. As was paying out of pocket and could no longer afford his service, I went to Planned Parenthood in July of 2017 for my pap smear which they promptly deemed as unnecessary. They told me to return in a year. In February 2018 my pap smear was negative. I have a few questions concerning protocol.

My doctor did not mention the HPV and there was no dialogue established regarding transmission. It was not treated as an STD. Therefore, I engaged in unprotected sex with people without disclosing my HPV status – which were only confirmed to me when I had my medical records mailed to me earlier this year. The initial results for the Pap in October 2016 stated that I had HPV, but it did not specify which type. Also, the colposcopy and the subsequent paps did not mention HPV infection. Why did my doctor not inform me of potential risks to my partners? Should I call everyone I had intercourse with during this time that I was HPV positive and inform them even though it’s been years? I feel immense guilt over this and am wondering what the standard practice for something this nuanced would be. I understand HPV infection is ubiquitous but it was also my responsibility to do my own research and I should have understood that LSIL = high-risk HPV.

Why was I not tested for HPV on my colposcopy and subsequent paps? Why was the HPV type not specified? Can I request that my next pap smear include a type specific HPV test? (I have my next pap next week.)

Edward W. Hook M.D.

79 months ago

Welcome to the Forum. I'll be glad to provide some advice and to comment. You do not mention your current age or whether or not you have received the HPV vaccine. Given your concerns about HPV I would recommend the vaccine for you.

Your detailed timeline and history is helpful and a good demonstration of how so much of how we approach HPV has changed over the past 10 years. During that time the way PAP smears have reported has changed, as has how tests for HPV are used. For your information CIN1 and LSIL are similar diagnoses on the continuum of how low grade PAP smear abnormalities with little chance of progressing to cancer are reported. Some of these results but not all are due to HPV and as a result, HPV testing is now recommended for these results. In 2016 not all CIN1/LSIL results would receive HPV testing but certainly today they would most likely be. In regard to your test next week, I would discuss with your GYN and request and HPV test. Hopefully they will do it.

You are good to worry about whether or not you might has HPV and have exposed partners to the infection but I would suggest there really is no need to worry. We do not routinely recommend telling partners about PAP smear abnormalities or HPV diagnoses for several reasons including that they are so widespread in unvaccinated sexually active persons, that they should not be a concern in vaccinated persons, and that they are of little health consequence for more than 99% of persons with HPV of any type. I would suggest that you look at some of our past comments on the forum to others with questions about HPV on the forum for additional detail on our perspectives on HPVand partner notification but again, to repeat the "bottom line", we do not see a pressing need for routine notification of partners regarding HPV infections and I do not feel that you need those em out prior partners to otify them, no matter what the results of your next PAP smear show.

I hope this comment is helpful. If there are further questions or a need for clarification, please use your up to two followup questions to seek clarification. EWH

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79 months ago

Thank you for your timely response, Doctor.

Am I to assume, because my Hpv results from the first Pap smear came back as positive, that I was positive for a high risk strain? Do they test for low risk strains? (Wart-causing strains)

If I am positive for HPV type 16, the leading cause of oral cancer in men, do I have a greater obligation to disclose to past partners?

Also, how long does it take for HPV to turn into Cin-1? I had a partner for a little over a year prior to the Cin 1 diagnosis. Could he have given me the hpv that led to the cin 1? Or, is it more likely that I had the hpv for years and cell changes only happened recently.

Thank you for your help.

Edward W. Hook M.D.

79 months ago

Not necessarily. Many persons with CIN-1 or LSIL have lower risk HPV. Some HPV typing systems type for lower risk HPV types as well as the highest risk HPV types. Please remember that even with a so-called "high risk" HPV type, over 99% of infections will not progress to concern and most of these will resolve without therapy. Thus as I said above, there is no obligation to notify sex partners if you happen to have HPV, no matter what types (did you look at some of our other interactions on this subject with other clients as I suggest?)

the time that it takes HPV to progress to CIN-1 is quite variable. When a person has HPV or HPV-related PAP smear abnormalities, unless they have had multiple previous negative HPV tests, there is no way to know how long the infection has been present.

I hope this is helpful. EWH

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78 months ago

Thank you for your response.

I have an additional question regarding an issue I have not seen readily address in this forum - anal HPV. As my long term partner and I engaged in unprotected anal sex, though infrequently, during the time that I had an active HPV infection, what is the risk of anal HPV in women and is this something I should have my practitioner screen me for?

Edward W. Hook M.D.

78 months ago

Your question is a good one and, unfortunately, one that there is not a good answer for. Emerging data indicate that, irrespective of gender, participation in unprotected rectal intercourse does put you at risk for rectal HPV and that associated with this, there may be a small risk for rectal cancer. The until it's of rectangle Pap smears is currently unknown. My advice, n the context of your specific situation and our earlier exchange is that it may be reasonable to have a rectal Pap.

This topic is currently under study but clear answers are unlikely to be available for several,years.

I hope this response is helpful. As per Forum guidelines, we provide up to three responses to each client. This is my 3rd response, thus this thread will be closed shortly.

Tace,care. EWH

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