[Question #5167] persistent other high risk type hpv

23 months ago
5 years ago. I did disgusting things of multiple risky encounters outside of marriage. I then noticed a single growth on my scrotom which a dermatologist said could be a wart. Biopsy said it's a wart but the IHC test they did on biopsy sample for hpv 6,11,16,18,31,33 were negative. I broke down and told my wife. She did pap smear and was normal. No approved hpv dna test at that time. I asked the biopsy to be sent to another pathologist to review and she said it's not wart. The growth never came back and my wife's pap has been normal so I've put this behind me until now. Last summer my wife bleeds during sex. She did a pap and it was normal. Last month her annual pap was ASCUS. They then did hpv pcr test (cobas) on the same pap smear sample and shows positive for one or more of the 12 other high risk types (pooled test) but negative for 16 and 18. She will do colposcopy but is devastated for this. For the last 5 years I've not had anything outside marriage and neither is my wife  so she's had this strain for at least 5 years. 
Any reason she could not clear it beside her age (she is 36 now)? She has demanding job that she often works till after mid night but she. Since it’s persistent, will it ever become normal if left untreated or even with LEEP?  If my wife is able to clear it, will a repeated pcr test be negative? 
Could HPV16 be present in other area of cervix so it’s not detected? I really hope we’re at least truly 16/18 negative. If so, would it make the possibility to cancer less? We can worry less about anal cancer since 91% of anal cancer is by HPV16? Should both of us do regular anal cancer screening? I want her to be safe but also don’t want to frighten her even more. I have hemorrhoid so have blood when wipe myself after stool. The enormous guilt and anxiety has destroyed me. She is in Asia now and it will take several weeks for the colposcopy result. Could this thread be open for longer time so I could follow up once colposcopy result is available? Thanks!
Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
Welcome to the Forum.  I'll try to help.  My sense as I read your comments and questions are that you have gotten a bit ahead of yourself, asking a number of "what if" questions.  In addition, your concerns in part reflect the evolving knowledge of HPV,  Please remember:
1.  This all started with the discovery of a scrotal lesion which may not have even been a wart/HPV.
2.  As you point out, your wife's HPV infection may well be longstanding and unrelated to your dalliance five years ago.  If your wife had partners before you, it may not have been acquired from you.
3.  Her HPV+ ASCUS diagnosis does NOT mean the she will get HPV-related cancer.  The vast majority of HPV+ ASCUS does not progress to cancer. Most of it resolves, some persists without progression.
4.  There is a well-described logical approach to evaluation of her situation involving repeated examinations and, if warranted biopsies.  With this kind of care, even if the disease is progressing, it can be managed,
5.  With or without LEEP (IF it comes to that), the infection is more likely to clear than not.
6.  Your concerns about HPV 16 and 18 at other sites are somewhat overstated.  Certainly infection may occur at sites which were not sampled by earlier evaluations however it sounds like her evaluation has been thorough.  the fact, along with a plan for future evaluation as recommended by her doctors should deal effectively with this problem, either ruling out infection orr if infection is discovered, addressing its management.
7.  Your notation that 91% of anal cancer is due to HPV 16 fails to acknowledge that less than 1-2% of anal HPV progresses to cancer.  

I urge you to take a deep breath, appreciate that without knowledge of her infection nothing would be done about it, and work to move through this with your wife.  Address your guilt.

I will try to keep this thread open  until there have been three interactions but sometimes this is difficult to do.  I hope my comments are helpful.  EWH
---
22 months ago
Update: wife’s biopsy after colposcopy was”cervicitis with focal mild koilocytic atypia, suggestive of hpv effect. no definite Cin”. So I guess this is abnormal but less than cin1? It seems this still counts as LSIL. Dr H mentioned in #1933 that cin1 almost never progress to cin 2/3 and if an infection is prone to progress it begins as cin 2/3. But in #1362 he suggested that this probably represents infection with low risk type. Not sure if this still applies to high risk hpv but less than cin1. If my wife is able to regress it to hpv test negative is this more likely to be a one time thing or with repeated/late recurrence?  I saw posts here that cin1 regressed then a few years later HSIL. Several studies have shown reactivation at older ages. But asha website hpv myth and facts cited an Albert Einstein univ and univ of Washington study that hpv is likely eventually rooted out of body. Is there a reference for this study? Some websites mention life long risk of recurrence and carcinogenic. This is really scary but it does seem to be true very unfortunately. Anal cancer: literatures list women with cervical neoplasia and men with genital wart as high risk groups for anal cancer that should have annual anal cancer screening per NYS guidance. But all the studies I’ve seen focused on HIV+ patients including the big ANCHOR study. Wonder how could anchor study inform other risk groups. Or maybe other high risk groups need not worry so much now? Some sources mention anal cancer incidence is similar to cervical cancer before pap screening. I cannot find the incidence rate for the risk groups relevant for us. But if this statement is true then anal cancer screening seems something must be done. I don’t even want to think of oropharynx cancer but according to cdc there’s already more hpv caused oropharynx cancer than cervical cancer. The more I research the more it seems we are just going to die from any one of these cancers sooner or later. I intend to have an anal cancer screening. But I know it will increase my anxiety/fear if hpv or even cell changes were found. If my wife never developes cin3, she doesn’t need to worry about cancer at other locations, right? Also if my scrotam wart ever recurs, is it more likely to be around original location than anus? I’m also very surprised that there’s little effort to develop anti-hpv medications. Only very few small biotechs are developing therapeutic vaccines with lackluster efficacy. This is dramatically different from other viruses. Hcv is cured and hiv can be controlled. I hope experts could stress this need so  drugs may be available sooner.
Edward W. Hook M.D.
Edward W. Hook M.D.
22 months ago
I continue to think that you are worrying entirely too much about something that you cannot do anything about and may not be responsible for.  There is much overlap between LSIL and koilocytotic atypia.  some is due to HPV, some is not,  When it occurs in the setting of HPV, irrespective of the type the vast majority (certainly over 98%) of changes resolve without therapy and HPV is no longer detectable.  The sense is that when the changes regress they do not usually recur although in some instances this may occur (no specific figures for this).  

Few specialists would suggest and need for anal PAP smears at this time.  

Your post, which is a bit rambling, suggests that you are more anxious about this than is appropriate and they you have been searching the internet, something that we specifically advise against as so much of what is there is misstated, out of date, or taken out of context.  

Please take a deep breath and relax.  EWH
---
22 months ago
Just when I thought things are already bad enough, I got another big punch. The wart has returned after 5 years. Found a small flat growth in pubic area close to my groin. 1.5mm length. Slightly darker than skin color. With magnifying glass and phone I got a closeup look. The surface is not smooth. Looks just like wart pictures online. Trying to see if I can scratch it off with my nail but only made it bleed. Don’t know how long it has been there as it’s small and hided in groin area and I usually only check the area of original wart. My guess is it’s within last 6 months. This is far from the scrotal wart 5 years ago with different appearances. Why would wart recur after 5 years at completely different locations? Maybe I was infected at different locations at different time and this one just showed up after 5 years? Won’t be able to see dermatologist until 5 days later. Will ask for biopsy regardless of diagnosis. Don’t know how much worse things can be. 
Edward W. Hook M.D.
Edward W. Hook M.D.
22 months ago
I think you are over reacting.  This may not be a wart.  The history you provide does not fit and the location is a VERY unusual location for a wart.  What you describe sounds like an actinic keratosis, a skin tag, or other non-STD lesion.  When anxious persons begin to closely scrutinize their genital area they tend to find many previously unnoticed cutaneous abnormalities which are of no clinical concern.  

This is my final reply as part of this thread.  As you know, we provide up to three responses to each client's question. This is my 3rd response.  Further "what if" questions are most unlikely to be helpful to you until at least after you have seen a dermatologist.  EWH
---