[Question #7141] HPV/STI in regards to sexual history

9 months ago
I am a 40yo female. In my late teens and early 20’s I was a bit wild and had quite a few sexual encounters. I’ve had 2 healthy  pregnancies/births since then. I am now pregnant with my 3rd. About a year ago my PAP came back positive for high risk HPV with cell abnormalities. I’ve had 2 follow ups since with no changes. I let my anxiety get the best of me and had a bunch of tests done. All the STI tests came back negative (aside from HSV1, but I get cold sores in my nose so I’m pretty sure that’s what that is). I also donate blood so I know that syphillis (sp?)  and hepatitis are also negative. 

My questions are these; 

If I’ve tested negative for all those STI’s is there any chance of me having something laying latent after all these years? 

I am 2 months into my pregnancy- should I be concerned over that HPV positive PAP? 

Does my partner need to be concerned in regards to my PAP results? 
Edward W. Hook M.D.
Edward W. Hook M.D.
9 months ago
Welcome to our forum. Thanks for your confidence in our service. I’ll be glad to address your questions. Congratulations on your pregnancy, I hope all is going well.

That you were infected with HPV in your youth is no surprise. The majority of Americans who have not been vaccinated for HPV are infected with the virus. Only a small portion of infections go on to cause difficulties and the presence of a so-called high risk HPV should not negatively impact the outcome of your pregnancy.  Regarding your specific questions:

1.  The currently available tests for STI’s are amongst the most reliable tests in all of medicine. Testing is a routine part of evaluation early in the course of pregnancy. If your tests are negative there is virtually no chance that your testing missed an infection. I would not be the least bit worried about a chance of other latent  STI’s.

2.  The fact that your HPV tests and Pap smears are stable is reassuring. Typically, the presence of HPV infection has little effect on pregnancy outcome. There is no rush to address this and your OB/GYN will be able to manage this, if necessary, following your pregnancy. I should add that the presence of HPV in pregnancy carries virtually no risk to your unborn child.

3.  Your HPV infection should be of no meaningful concern to your partner.  He is more likely than not, already infected. As long as he has no abnormal lesions or problems the possibility that he has an HPV infection should not be a concern to you or to him.

I hope that these replies are helpful to you. If any part of my reply is unclear or there are further questions please don’t hesitate to use your up to two follow up questions for clarification.  EWH

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9 months ago
Thank you so much Dr Hook! 

Your answers have alleviated much of my worry. I wish HPV was discussed more openly and not so stigmatized. People just focus on the STI part and don’t bother to further educate themselves. 

I have a couple follow up questions:

Can HPV cause vaginal cancers (vs cervical - ie: in vaginal wall or labia)? 

If I choose to have a hysterectomy or something after this pregnancy is it possible to just remove the cervix itself? 

Is HPV a lifelong infection? I get confused over the fact that HPV ‘clears’ witching so many months, but it can also lay latent and undetected for years. 

Thanks again!! 
Edward W. Hook M.D.
Edward W. Hook M.D.
9 months ago
Thanks for your reply.  We certainly share your wish that folks could get over their stigmatization and unwarranted concerns over this very manageable virus.  On to your follow-up questions:

1.  Yes, HPV can cause vaginal cancer although this is far rarer than cervical cancer which occurs in only a tiny proportion of all cervical HPV infections.  Both should be detected with recommended GYN checkups.

2.  I do not think a gynecologist would only remove the cervix and leave the uterus behind but this sort of surgery is not my area of expertise.  Better discussed with your obstetrician/gynecologist.

3.  Great question.  The vast majority of HPV infections then clear and while there may be occasional instances when the virus may later he shed later, after clearance, this does not seem to cause problems for most women.  Further, these recurrences do not occur in all infected persons and tend to become less common with the passage of time, this is an area of ongoing research, the significance of which will be better defined in the future.

Hope these comments are helpful.  EWH 
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9 months ago
I have one last question if that’s ok. 

How common is it for genital warts to appear during pregnancy? 

Thanks again - this information is very helpful!
Edward W. Hook M.D.
Edward W. Hook M.D.
9 months ago
Pregnancy can certainly make genital warts that were not noticed before become more apparent. The effects of Pregnancy can also lead to increased size of warts which were present before.

Thanks for your thanks.  We provide up to three responses to each question.  As this is the third response, this thread will soon be closed without further responses.  I hope your pregnancy goes well, take care.  EWH 
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