[Question #5467] HPV16 Reactivation Please Help

20 months ago
Hi there,

Please help me. I'm spiraling. I used to have a high risk hpv infection with an abnormal pap. I've since cleared the infection (normal pap and HPV negative).

I found this article: https://academic.oup.com/jid/article/208/3/403/2192562

It's from a very reputable source. It has a large study. It says that those who have a prevalent hpv16 infection can reactivate their virus. I want to put hpv behind me since I'm cleared. Now that I know there are risks for reactivation, I feel the need to tell future sex partners to get vaccinated. I don't want to have this burden on my shoulders for the rest of my life. I don't want to feel the need to tell all sex partners to get vaccinated, but i know there is a risk of oral cancer associated with hpv 16 in men. In fact, it's now the most common hpv associated cancer (specific to men) second only to cervical cancer.

This article says that most of the re-detected infections are from new infections (hpv has weak natural immunity), but the same cannot be said for those who had a prevalent infection. Prevalent infections are more likely to reactivate after clearance. I think my infection can be classified as prevalent since I had actual cervical changes (mild) as a result of the hpv. I don't want to reactivate my infection a few years down the line and accidentally infect someone. I also don't want to feel this burden and guilt for the rest of my life.

Please help, I'm panicking about this so much .

I already had a similar conversation about this with doctor Hook, but we didn't discuss this article. Please can you read it for me and tell me if you can give me reassurance.
20 months ago
Please note, there is a difference between re-infection and reactivation. I'm worried about reactivation. I got the vaccine after my initial positive test. so I should be good from re-infection.
20 months ago
Figure 1D shows that none of the incident cases that cleared their second detection had a reappearance, whereas 7.7% (95% CI, 1.1%–43.4%) of prevalent cases had a third detection by 3 years and 50.4% (95% CI, 22.8%–85.1%) by 12 years (P = .04).
Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
In your earlier interaction you mentioned your anxiety disorder and thus I am comfortable with suggesting that your continuing concerns and inability to stay off the internet as you said you would are a reflection of you r anxiety disorder.  It appears to have overwhelmed you- please seek care.  Further your condition has caused you to mis-interpret the data from this older, relatively small (2500 women in an HPV study is small) study (note- women were enrolled beginning in 1990 which I believe may have been before you were born and reflects data collected before 2007.  Finally, you are mis-interpreting where you would have fallen in this study population since your HPV was detected and then cleared you would be in the incident not prevalent group -incidence and prevalent groups were defined on HPV DNA status at the time of enrollment See STATISICAL APPROACH, sentence1.  Irrespective however, you are clearly over reacting.  I will not re-iterate the information I provided to you in your earlier post. 

For you to fixate on the possibility of reactivation is a total waste of time and energy.  You do not know that you will and the odds of re-activation (even in the study you are misquoting) are small (most women did NOT reactive over the more than a decade of follow-up. Thus your option is to get regular reproductive health check up and move forward with your live, not walk around worrying that you MIGHT reactivate.  If you do, then you should consult with your gynecologist (who would most likely recommend observation, should this unlikely event occur.

Again, I urge you to stop worrying about something you have no control over (possible reactivation) and to move forward with your live. Should you reactivate, it is not an insoluble problem.  In the meantime, what you can do is address your anxiety issues which appear to be seriously impacting you at the present time.  I say this out of concern, nothing more.  Further I ONCE AGAIN, URGE you do stay off the internet where you are likely to once again, be misled.  EWH 
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20 months ago
I sincerely apologize for the constant questions, I got diagnosed with HPV about a year and a half ago, and ever sine then I've been in this state. I found this article weeks ago and since we didn't get to go over it in our last exchange it kept bothering me, so thought I may as well ask. I desperately want to let this go, but have a hard time given this article. If you can help me further debunk I would be very grateful.

I'm confused on how you know I don't classify as I prevalent infection. If that's the case I would feel a lot better, so can we focus on that?
"incident or prevalent (defined as by HPV16 DNA status at enrollment)" - does this mean that if the subject was HPV positive at enrollment (baseline) then they were classified as having a prevalent HPV infection. If they were negative then they would just test the subject until they became positive, thus classified as an incident infection? That's how I interpreted it, but clearly I constantly misinterpret things. I tested positive for hpv twice before going negative. Does that classify me as having a prevalent infection? These subjects were an average of 19-21 years old, so it's not like they'd had years and years of hpv persistence. Either way, regardless of the subjects being incident or prevalent, they would've needed to clear at least once the infection in order for "redetection" to be estimated.  "In these women, we first estimated the distribution of time to clearance as defined by 2 consecutive negative tests for HPV16 DNA, taking the initial positive visit as the time origin. Among women observed to clear according to the above definition, we also estimated the distribution of time to next incident HPV16 DNA detection, taking the time of the first of the 2 consecutive negative tests as the time origin."

Lastly, is it fair to assume that those "50.4%" of prevalent infections who had a hpv16 re-detection within 12 years was due to reinfection versus reactivation? I wish I could just assume that, but this statement gives me doubt "Interpretation is more complex in women with prevalent infections, as this group appears to include a subset of women with failed immune responses resulting in HPV persistence. The recurrent detection of HPV in these cases may reflect reactivation"

Again, knowing what the authors meant by "prevalent infection" is key here.

let me know if you have any insight.
20 months ago
Also it is unknown how long the hpv infection before testing positive for it twice... again, I could easily be considered a prevalent infection (assuming my interpretation of prevalent is correct) which i think it is since I cant think of any other way to define it despite my best efforts.
20 months ago
and I'm not so certain that 50.4% is small like you say :( I really wish it was. I really wish I never read this article .
Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
Start by looking at what you have just done- three sequential responses in short order is problematic and HPV has NOTHING to do with this.  Get your anxiety addressed.  Your HPV is not a problem, as I have said repeatedly.  I will provide several brief answers to your repetitive, anxiety driven questions which derive from your misreading of the OLD paper that you dredged up in your anxiety-driven internet search.. I am sorry if this seems harsh- consider it "tough love"- you are out of control and it is not your HPV that is doing this.

You are currently a "prevalent" case as defined by this paper- your HPV DNA is negative (twice per your earlier description).  The paper describes persons arbitrarily defined as "prevalent" as those who were HPV positive AT THE TIME OF ENROLLMENT in the study.  You are currently HPV negative.  Were you to enter this study, you would be places in the incident group IF you became positive during the observation period.  No doubt many of the persons enrolled in this study had prior HPV infections and cleared it before the study enrollment.  EWH
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20 months ago
Fair enough.
So then to wrap up, after what you've seen in this article and knowing my situation, how much do you think I should worry about giving a partner oral HPV that can potentially cascade into oral cancer. Again, hpv oral cancer rates in men are synonymous to cervical cancer rates in women. I think that right there is my biggest fear, and after reading this article I fear that I could reactivate in a few years and inadvertently infect someone...
20 months ago
Also, just for every day knowledge, you mentioned that this article is old a bunch of times. Can you explain to me how this diminishes it's value/accuracy?
Thank you.
Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
I appreciate your concern for others but I really do not think there is anything you need to do.  The topic of oral HPV is still evolving and is years behind what we know about genital HPV infections.  We do know however that oral infections are far less common than genital infections and that when they occur,like genital infections the vast majority will resolve on their own and not lead to oral cancer.

In that this is the final reply as part of this thread and because future repetitive, anxiety-driven questions may be deleted without an answer and without refund of your posting fee, I'd like to summarize a few recommendations that may be helpful for you going forward:
1.  You had HPV it resolved. There is a small change that it may recur and if it does, it will likely be picked up as you pursue recommended sexual health check-ups.  Should it recur, the likely first step will be continued observation.
2.  You have had the HPV vaccine. If anything, this may decrease your chance of recurrence (still a topic of research) and will certainly greatly reduce your risk for reinfection.
3.  There is nothing to be gained by disclosing your past infection to past partners.  Most past and future partners will either already have HPV whether they know it or not, or if they have had the vaccine, will not be vulnerable to infection.
4.  Please review other threads on this site regarding HPV.  You will find many consistent, data-informed messages regarding HPV and its natural history.
5.  Address your anxiety with professional help
6.  Stay off the internet.

This completes this thread which will soon be closed.  I wish you the best.  Please do not worry and please, please address your anxiety problems.  EWH
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Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
Final answer to the question you posted while I was writing my past reply - older articles are superseded by more current data.  Nothing in that paper was a surprise and it added little to current knowledge regarding HPV.  EWH---
20 months ago
Thank you Dr. Hook. I appreciate your patience and diligent response.