[Question #514] HPV16 questions

44 months ago

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Hello! Background: 43yo female, normal paps every year since 18. I have been in my current relationship for 5 years. In Jan 2014 with my pap, I was tested for HR HPV. It came back pos for HPV16. I then had a colposcopy that came back normal. Since then, I have had paps every 6mo and 1 more colposcopy. All normal, but the HPV16 is still positive. Now I'm a new mom, and the idea of having this cancer causing virus is stressing me out. My Dr. has told me as long as I'm testing every 6 mo, not to worry, and there is still a chance I will clear the infection. I have been online and read some scary stuff. I also read that a huge percentage of people have been exposed to HPV. And that almost all cancers of the cervix, vagina, vulva, certain area of the throat, penis, and anus are caused by HPV16. 

My questions:  While I see that these cancers are considered "rare", how rare are they if you have HPV16? So millions upon millions of people have or had HPV, but what about this cancer causing strain of HPV16? If only a small # of people have this strain, then the # of cancers might not seem so rare at all to those of us who know we have HPV16. 

Re: sex. I am very concerned for my husband. To be safe, I would never allow him to perform oral sex on me again. And perhaps I should not on him? I'm not sure what to think there. I don't know who gave the virus to who. Is it a good idea to avoid oral sex since I know I have HPV16? Or is it too late now?  

Is it true there is still a chance I could clear it, even though I am 43 and it's persisted for at least 2 years now? 

Lastly, I am concerned that if the virus is perhaps confined to my cervix now ... by having sex I could spread it to other areas that are then susceptible to cancer (Vagina, vulva, anus, etc) Is this true? And should I be testing those areas for HPV? Or having oral cancer checks for both of us?

Thank you so much for help with my questions
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago

Welcome to the Forum.  we get more questions about HPV and its significance than we do about any other STI, by far.  I can understand that, the idea of a widespread STI which causes cancer is scary, particularly when you start to worry about your partner.  I hope that my replies, reinforcing what your doctor has already told you will help. 

HPV is not only the strain of HPV that causes most gynecological cancer but it is also the most common HPV.  Women with a single sex partner acquire the virus at a rate of 10-15% per year after starting to have sex.  Most of these infections clear with time and only a small fraction of 1% go on to cause cancer.  Clearance occurs more slowly in older groups of women (sorry, at least in the HPV world, you fall into this group) s.o I am not overly worried that your infection will not clear.  Further, you have a doctor who is doing just what needs to be done, watching closely for signs of progression which, in the unlikely circumstance that they occur, can be reliably treated.

You are good to be concerned about your husband but this is not the time to let this infection interfere with your sex life.  He has, without doubt been exposed and is at far lower risk for development of cancer or pre-cancerous problems than you are and as I said about, your risk in tiny.  As for oral sex, here is something my colleague Dr. Handsfield wrote recently which I think is right on target- "... oral HPV. On average, at any point in time, it's about a quarter as common as genital HPV. That's a good news/bad news scenario: not as common as genital, but frequent enough that a very high proportion of sexually active people (probably over half) get oral HPV at one time or another. Second, oral HPV is probably not acquired only by oral sex. In the largest US national study of oral HPV, its presence was correlated with no. of lifetime sex partners, but not with frequency of oral sex. So it is likely that oral HPV often (usually?) is acquired by less direct exposure, such as auto-transfer from one's own genital infection, and perhaps because sexual fluids get spread around quite a bit and can easly get into the oral cavity without oral sex. (Sex is inherently sloppy, right?) Third, a higher proportion of oral HPV infections, compared with genital, cause no symptoms and no disease; and almost all infections are cleared by the immune system. Fourth, transmission of HPV from oral infection to partners appears to be uncommon. While oral sex may account for a few genital infections it partners, it is far less likely than genital to genital transmission."   I agree and see no reason for you to worry about sex, oral or otherwise with your husband.

Finally. many HPV infections are what is called "multicentric" and cells from your cervix regularly contact other parts of the body.  Those areas however need not be tested for HPV- just keep doing what you are doing.

I hope these comments are helpful.  EWH


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44 months ago
Thank you for the information. It's very helpful. Did you mean to say that HPV16 is the most common strain of HPV? I wasn't clear on that sentence. Also, if only a small fraction of 1% go on to become cancer, is that percentage higher in persistent infections that do not clear? 

Regarding the HPV cells on my cervix, getting to other parts of my body via sex, does your answer mean that this could happen anyway, it wouldn't just happen via sex?


Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago

Yes, I did mean to say that HPV 16 is the most common strain of HPV.  Most people acquire several types of HPV during their lives.  Among them, HPV 16 is more likely than others to persist as well.  Certainly infections which persist are more likely to evolve into cancers but even then, the percentage which go on to cancer is quite low. 

Regarding contact with HPV infected cells, this could occur even in the absence of sex.  EWH

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44 months ago
Okay, so my takeaway from this is that HPV16 is not rare, but the cancers it's linked to are. While it's the most common HPV strain, the vast majority of people are infected by other, less dangerous strains. Are those correct assumptions?

One other thing that came to mind before this closes out my session. In another post, I saw that Dr. Handsfield wrote to a person that they probably did not have HPV16 as their pap results were ASCUS (or some other lower level grade), and commented that if it were HPV16 the dysplasia would likely be more significant. So that brings me to question of how I can be HPV16 positive now for 2 years (perhaps longer if I was only first tested in 2014), yet be having normal results on paps and colposcopies. Is it uncommon to have active/detectable HPV16 and yet not have dysplasia? If so, it would make me wonder if they are missing the affected cells on these tests.

Thank you again so much for your help. I have read quite a bit of terrifying information on the internet and have been feeling like a ticking time bomb for a few months now. The information I have found here has helped settle my mind some. 
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago

Your takeaway is on target, good job.

Regarding HPV 16 and dysplasia, most persons with HPV 16 do NOT have dysplasia and, even when dysplasia is present, this most often resolves with time.  It does not trouble me that your PAP smears have been negative.  While any single PAP might miss dysplasia if present, you have had multiple PAPs AND atwo colposcopies- if there were dysplasia present, it would have been detected.

I'm pleased you found my comments helpful.  The internet is a wonderful source of general information but it also can all too often be misleading and a bit overly dramatic.  Stick with your doctor and try to keep off the internet.  EWH

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