Dr hook

followup to #6741 in regards to bleeding. After Pap where bled for 3 days been bleeding off & on for the past month. Sometimes for 3 days at a time Other times spot here or there w/ discharge. This in addition to my bv infection has me concerned. Yet dr still insists Bc pap & hpv were fine that I am ok. However came across old test results that have me concerned. 1^stabnormal pap in 2009. test positive for hpv & abnormal cells on cervix (pap lsil rule out hsil & agus) in 2011 (believe colposcopy done at this time as well). dr later did colposcopy that showed cin1 but pap was cytologically normal & hpv neg. 6 months later area suggestive of mild/mod dysplasia but biopsy showed possible HPV effect & pap showed no cytologic abnormality & high risk hpv neg, approx. 6 months after that only pap was done which was hpv neg. Dr then had me come for pap smear at 6 month interval for 1 year & said could use standard guidelines for repeat colposcopies.  Since then paps and hpv tests have been good (as far as I know). no colposcopies have been done. This has me questioning my dr now that hpv/cervical cancer have nothing to do with my symptoms if tests can be normal/neg like mine were in past yet I had abnormal cells. Also, I am confused as to why my dr did not do a repeat colposcopy despite fact still had hpv effect (and tests where coming up neg yet my cervix still had this issue).last two tests in dec 18 & feb 20 were neg/normal. Will ask dr about but would like your thoughts

Welcome back to the Forum.  I'm sorry this continues to be stressful for you.  I agree that it is a good idea to talk this through with your GYN.  As I believe I mentioned to you in our earlier interaction, PAP smears are not perfectly sensitive tests but tests for HPV are better.  In both cases testing is looking for early signs of a process which most often resolves on its own but occasionally can slowly progress to pre-cancerous or cancerous lesions.  Earlier stages of PAP smear abnormalities such as ASCUS and CIN are more likely to resolve spontaneously and may reflect changes at the cervix that are due to things other than HPV.  As PAP smear abnormalities progress through CIN II and CIN II, they are more likely to be HPV-related and less likely to resolve although many such abnormalities do still change. 

Part of the reason for HPV testing is to avoid unnecessary colposcopy, biopsies and their complications (which as you know may include spotting after the procedure).  If the HPV test is negative, colposcopy is not warranted.   HPV "effect" is really possible HPV effect.  If the test is negative, there is no need for you to be put through another colposcopy.

It sounds to me like your doctor is doing things right.  Please remember that HPV-related progression to pre-cancerous and subsequently cancerous lesions is a process that typically takes years to occur, allowing clinicians and their patients the opportunity to follow and test repeatedly to avoid unnecessary procedures. 

I hope this explanation is helpful and anticipate that your own doctor will say something similar. Please feel free to print  out this response and to share it with your doctor.  EWH

Thank you for your reply. I called and spoke with my dr and they did not seem concerned at all.

However, I have some followup questions for you:

After my pap and hpv came back normal, my dr did not do another colposcopy/biopsy despite fact that there was evidence of hpv effect on last one they did. Is that standard procedure? Why would it show hpv effect on biopsy yet my tests came back normal and negative? If the abnormal cells in my cervix did not resolve, is there a chance that my pap smears and hpv tests would not have picked up on the infection since 2012 and that’s whats causing the bleeding now?

 Im also wondering if my most recent tests are accurate, if my tests in past came back okay but I had abnormal cells in past (could that happen again where there are abnormal cells yet tests say everything is ok?) I know that you said hpv takes years to progress to cancer but Im worried that my doctors are not taking the bleeding I am experiencing seriously. At first they said it was due to the pap smear I had or fact that I was breastfeeding. Now that it has continued on and off for a month, they said its probably the breastfeeding. I just called them and they said If it does not resolve in a couple of weeks to come in for an ultrasound. Yet, at no time have they mentioned hpv/cervical cancer as a possible culprit of this bleeding. I want to accept that they are correct, yet I know irregular bleeding and bleeding after a pap smear are symptoms of cervical cancer. I mentioned my concerns to them but they did not seem to be concerned at all with my prior hpv infection. 

Apparently both your doctor and I are comfortable with the results of your tests but you are not. This worries me.  Past experience tells me that on occasion, when clients don't like a result, if they look long and hard enough they will find someone willing to do the procedure or give the medicine the client thinks think they need.  I worry that you may be approaching this stage.  Hopefully my responses will help you accept your doctor's assessment

1. After my pap and hpv came back normal, my dr did not do another colposcopy/biopsy despite fact that there was evidence of hpv effect on last one they did. Is that standard procedure? Why would it show hpv effect on biopsy yet my tests came back normal and negative?

Yes, as I and your doctor have told you.  This is an appropriate response.  The PAP smear abnormalities which show "viral effect" can be non-specific be caused by other, non-dangerous issues such as inflammation or perhaps in your case, BV.   Alternatively, there may be another, rarer, less problematic HPV type present.  Either way, follow-up, as suggested by your doctor,may be the appropriate response. 

I think you need to discuss other causes of bleeding with your doctor, including that is is worrying you.  I would encourage you to ask as well why you should not be worried.  If your doctor feels this is of concern, rather than fixating on the possibility of cervical cancer, which tests for are negative, I would suggest you look for other reasons.  As I have already indicated, it is usual for HPV infections to resolve over time

EWH 

My dr (and you) say not to be concerned with hpv/cervical cancer in regards to my bleeding and other symptoms Bc of most recent test results. I am just concerned Bc tests in 2011/2012 came back normal and negative yet I had cin1 and hpv effect on the two different biopsies they did along with pap and hpv tests. 

So I am just wondering:

Why would the tests come back negative when cells were abnormal (Cin1 in one biopsy then hpv affect 6 months later) when I had this issue in 2011/2012? 

I just find it puzzling that two sets of tests 6 months apart could come back negative but upon biopsy that proved to be false.

That’s also why I am so nervous about results being ok this time with the bleeding since test results came back okay in 2011/2012 but I had the abnormal cells when biopsied. (worried that this is the case this time as a result) But my dr says Because tests ok prove that bleeding is from something else and that pap got a good sample this time and hpv test can pick up on smallest amount of virus on cervix and that my tests have been normal for years now. I spoke again with my dr to alleviate my concerns and she really said that all was good and just to watch to see if bleed after intercourse or if bleeding continues to happen since it seems to have stopped for now.  Im trying to do as you say and accept doctors assessment (and not go look for answers with other drs who may not be looking out for my best interests) but I am concerned that she really had no clear answer as to why tests could be okay but biopsies were not.

I'm sorry that you are having trouble with this.  I feel that these questions are repetitive and have been answered.  As I said above when I said "The PAP smear abnormalities which show "viral effect" can be non-specific be caused by other, non-dangerous issues such as inflammation or perhaps in your case, BV.   Alternatively, there may be another, rarer, less problematic HPV type present", cellular abnormalities seen on PAP smear can have multiple causes and when HPV tests are negative, it is less problematic and can be followed safely over time with repeat evaluations.    In other words, HPV "effect" is not always due to HPV.

Biopsies are invasive tests which cause their own set of complications and problems.  Your doctor is making what sound to be appropriate recommendations. 

This is my 3rd response to this question and therefore, as per Forum guidelines this thread will be closed.  In addition, I responded to your earlier question with similar answers.  My assessments are not going to change and I'm sorry you have found them unsatisfactory.  That said, I must warn you that further repetitive questions posted on this site may be closed without an additional response and without return of your posting fee.  I hope you understand and I wish you well.  EWH