[Question #5094] HPV 16 Question

26 months ago
Hello doctors! Question...I've got HPV 16 and another high risk strain (not 18). I had abnormal cells in Jan 2018 and a cone biopsy in Sept 2018, showing CIN III. My followup in January 2019 showed LSIL, so my doctor recommended a hysterectomy - leaving ovaries, due to persistent abnormal cells and also cervical stenosis thanks to a big cone biopsy. Also, I had clear margins but multifocal spots.

My question is this! What are the odds of me getting VIN/VAIN or other cancers from HPV16 after this hysterectomy? I read horror stories so I thought I'd come right to the experts for facts. Anything I can do to minimize risk? I've read the HPV shot could help prevent reinfection?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Welcome back to the forum. I scanned your other messagers -- and it looks like both Dr. Hook and I never really responded to your earlier questions about HPV16. At least for your first questions, I think we just forgot because other issues seemed higher priority. I assume (and hope) your husband recovered completely from his apparent viral meningitis!

It's good to hear your CIN III has responded well to treatment. I would have thought that regression to LSIL by pap smear a year after your cone biopsy would not have warranted hysterectomy, but perhaps just continued follow-up pap smears. However, such HPV consequences is not something STD specialists normally handle -- it's a gyn problem -- so I'm not questioning your gynecologist's recommendation. That said, hysterectomy is not minor surgery. You might discuss it again with your doctor and if any doubt about the right course, perhaps get a second opinion about it.

I'm not aware of any data on the frequency with which someone with precancerous cervical lesions due to HPV16 (or any other type of HPV) are at risk for new pre-cancerous development at other sites, such as the vulva (vulvar intraepithelial neopleasia or VIN) or the anus (anal, i.e. AIN.) (I know you know the meanings of these abbreviations, but others reading this thread may not -- and education of users other than the questioner is one of the forum's main goals.) So I cannot tell you how likely it is you'll develop either VIN or AIN. I believe the risk probably is very low. On the other hand, of course you should be on the lookout for warts, other growths, or non-healing sores of your anal and genital areas. But my bet is you'll never develop anything. 

As far as minimizing risk of future HPV complications, I'm afraid there is nothing practical to offer. While it makes sense to do standard things that might aid immune system health (sleep, exercise, common sense diet, etc) nohting is known to affect the risk of recurrence of HPV or progression to cellular abnormalities. Except one thing:  if you're a smoker, try to stop. Smoking (and profound immune deficiency like AIDS, cancer, chemotherapy, etc) are just about the only things known to have any effect on HPV progression. And for goodness' sake, lay off unproved "natural" immune boosters-- which I mention because you asked about "active hexose correllated compound" or AHCC in one of your other threads -- which is just plain quackery.

I hope these comments are helpful. Let me know if anything isn't clear. Apologies again if we didn't adequately address your HPV related quesions in your earlier threads.

HHH, MD
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26 months ago
Ha! I stopped taking AHCC, just bought a better vitamin. I don't smoke, so that's good. And, fortunately my husband recovered just fine...seems to be unrelated to my poor decision two years ago. Thankfully it seems like what I've walked away with is a couple high risk strains of HPV (I had my doctor test me for everything via labs), and that's being closely monitored by my OB. I appreciate your insight, the service that you all provide really helps anxiety and guilt driven people like me.

I appreciate you, Dr. HHH.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Thanks for the note of appreciation. That's why we're here!

I haven't looked closely enough to your original questions to recall the details of your apparent non-marital sexual event. But please understand that it is rarely possible to know with certainty when and where any particular HPV infection is acquired, and you did not necessarily acquire your HPV 16 (and/or other types) during that event. Assuming you and your husband were sexually active with other partners before your marriage, it is equally likely that you had had HPV16 for years, or acquired it more recently from your husband, who had been unknowingly infected. Perphaps there are details that nail down your extra-marital partner as the likely source (e.g. if he had a known HPV infection). But absent such strong evidence, don't go through life beating yourself up over that particular event. It probably had nothing to do with your current HPV issues.
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