I have had several children and been pretty regular about gyno visits. I had a negative HPV test in 2015. I have never had a Pap issue. However, I have a positive HPV test in 2019 and then a negative in 2020. Both my husband and I have had other sexual experiences before marriage. But we have been married for 20 years and we are in our 40's. How could HPV show up now after decades and after a negative test? Does this mean one of us had another partner since? Is this a stretch or is this relatively common?

Welcome to our forum and thanks for your question.  Let me back into my response, providing you with the bottom line comments first, followed by an explanation. 

This finding is NOT an indication of infidelity in your relationship.

So why did this happen and what does it mean?  Our understanding of the course of HPV infections continues to evolve.  You and your husband had other partners prior to marriage.  Thus on a purely statistical basis, it is more likely than not that you both had HPV prior to marriage which, based on your subsequent PAP smear and HPV results, "resolved" as is the case in the vast majority of HPV infections.  However, more recent research now shows that in persons with resolved HPV infection there are occasional episodes of "shedding" in which the virus replicates and then again becomes quiescent.  This fact, combined with the very, very high sensitivity of currently available HPV tests means that from time-to-time, testing will detect this transient re-activation.  I suspect this is what happened in your situation.  The fact that your follow-up test was negative is totally consistent with this.  My advice is to not use this test result as evidence of infidelity and to move forward with your routine sexual health check ups.

I hope this information is helpful.  If this is unclear, please feel free to use your up to two follow-ups for clarification.  EWH

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Thank you because it is so confusing. Is this situation relatively common or is this some type of extreme anomaly? 

This phenomenon is not at all unusual and as more and more testing for HPV is done we see it regularly.  As I mentioned above our understanding of periodic asymptomatic shedding of HPV is still a topic of ongoing research. EWH ---