[Question #7537] New HR HPV Pap Result - GYN is telling me my husband cheated. Please help.

4 months ago

Please excuse my rambling. I’m still floored by what my doctor is saying.


I’m a 31 year old female. No health issues. I’ve had a pap done almost every year since I was 18 and I’ve never had an abnormal result. I’ve been married and in a monogamous relationship for 7.5 years. 


My last pap was on 6/6/2019 and everything came back negative. It was the first pap since I turned 30 & they said I tested negative for HPV.


Flash forward to this past year and I had a baby in early spring. I had ongoing pain and bleeding for longer than with my first baby, so the new practice I was at said let’s do a full work up and pap on 12/11/2020. The nurse called back a week later and told me I tested positive for low risk HPV. I freaked out and asked if my husband was cheating because I’ve never had an abnormal pap and my last HPV test was negative. She said this was absolutely not proof of infidelity and that he likely gave it to me at the beginning of our relationship. I wasn’t happy, but I accepted it. I was still confused about everything, so I called my old doctor. He agreed. If it was low risk HPV, my husband probably gave it to me years ago and it wasn’t cause for alarm. He asked me to send over the records so he could look at them. I did.


He called me back and said everything he told me was inaccurate. He doesn’t know why the nurse told me it was low risk because all the paperwork said I tested positive for high risk HPV. He said they ran the exact same tests he did the year prior. He then told me he was sorry to have to tell me, but I deserved to know, the only way I was negative for HR HPV in June 2019 and positive in December 2020 is if I was exposed to it within the last year and a half. He said if I didn’t cheat, my husband did because the virility of these HR strains don’t allow them to go that long without causing an abnormal pap.


My husband is swearing on everything he didn’t cheat. Please help.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
4 months ago
Welcome to the forum. Thanks for your confidence in our services.

The main problem here is your doctor's poor understanding about HPV and the meaning of a newly positive test result -- or at least poor communication about it. A high proportion of newly positve results in the cervix (in association with pap smears) are not recently acquired infections, but reactivation of a prior infection. Negative paps with negative HPV testing do not necessarily mean HPV is absent. Everybody gets genital HPV -- it's a normal, expected, unvoidable consequence of being sexually active; indeed most people are infected more than once. Once acquired, HPV is suppressed by the immune system but not necessarily eradicated; HPV DNA may persist indefinitely, often for life. And periodically, but not always, that DNA can be detected. The reasons for such reactivation are not known.

As a consequence, HPV is often detected in persons in committed, monogamous relationships, from either of two mechanisms:  1) previoius inactive infection reactivates; or 2) it's a new infection, but follows reactivation in the partner. That is, your husband might have had reactivation of an old infection, now transmitted to you. Of course, HPV is a sexually transmitted virus -- and some new cases indeed occur because one or the other partner has had other partners recently. But that's increasingly uncommon after age 25 or so. (The reason the HPV vaccine is recommended only up to age 26 is that new infections become quite uncommon after that age.)

Accordingly, the nurse and the first doctor were correct about the likely source of your infection. THe second doctor apparently doesn't understand these basic facts about HPV. That "they ran the exact same tests" over the years has nothing to do with it. He is also wrong about the frequency with which HPV causes abnormal pap smears:  many infections cause no abnormality at all except for detection of HPV itself. It is true that high risk HPV types are more likely than low risk to cause pap smear abnormalities, but many infections with either type do not.

So your situation is a common one. If you have no other reason to doubt your husband's fidelity, you definitely should believe him. Presumably both of you were sexually active with other persons before you became a couple. That's when either or both of you acquired HPV.

Low vs high risk:  There's not really much difference between them. Two common low risk types are HPV 6 and 11, which cause genital warts and rarely cause cancer. The high risk types are the opposite:  rarely cause warts, and the main causes of HPV related cancer. But even with the HR types, the vast majority of infections do not in fact lead to cancer. (It's sort of like smoking and lun cancers:  smoking causes lung cancer, but the large majority of smokers don't get cancer.)

Finally, assuming you indeed had reactivation of an HPV infection acquired years earlier, you may ask "Why now?" Pregnancy is a state of immunosuppression:  the immune system is down-regulated so your body tolerates the massive foreign tissue in your body -- the fetus and placenta. HPV often reactivates during pregnancy. Either the pregnancy itself or possibly post-partum endometritis (a likely cause of the pain and bleeding you report) might have influenced all this.

Bottom line:  No worries about the source. Just follow your doctor's advice about evaluation and possible treatment of your HPV infection -- although if your pap is otherwise normal, probably nothing more need be done except perhaps follow-up paps or maybe colposcopy for a closer examination of your cervix.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
---
4 months ago
Holy cow. This makes me feel so much better. 

Thank you for your quick and thorough response. I still can’t believe that my doctor was so adamant about it. I wasn’t happy about the diagnosis, but I had just accepted the fact that my husband likely gave it to me at the beginning of our relationship. I can’t for the life of me figure out why this doctor would straight up tell me that my husband is cheating on me. He said he knew the implications of what he was going to tell me, but I deserved to know that this was the ONLY way I could’ve contracted it. He told me it can’t be passed through sex toys, razors, or anything else. He said it had to be oral, anal, or penetrative sex OR genital touching. He said if I didn’t do it, my husband did. I was devastated. 

He also said he wanted to retest the HPV and try to narrow down the strain. I tested negative for subtypes 16 & 18, but I tested positive for HPV Other - 12 Pooled. Is there a benefit to knowing the strain? They did not test me for the low risk strains. This whole thing has lead to conversations with my husband about his previous relationships that I never wanted to know. I likely carry other strains because he probably didn’t wear a condom with any of his previous partners *eye roll*. If I haven’t had warts by now (after 7.5 years), can I assume I won’t or can they still pop up after all this time?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
4 months ago
I'm sorry again to hear of this unnecessary ordeal. I hope someday your doctor learns more about the data on HPV natural course, transmission, etc. (You could help in that, e.g. have a discussion and perhaps even show him my comments. But I understand how difficult and stressful this might be.)

There is no reason to know the specific HPV type. It will make no difference in how this problem is further diagnosed and perhaps treated. Whether HPV 16, 18, 34, 43, or any of several others, the recommended diagnostic procedureds and treatment are identical. Your doctor is also wrong in his assumption about condoms, which are NOT very effective in preventing HPV. Completely consistent condom users have equally high risk and frequencies of HPV as non-users. (There's too much skin contact above the range covered by male condoms.) I don't want to over interpret things from the indirect information I have so far. But I think you should consider finding another gynecologist. It seems you're not being well served by the present one -- for sure from a standpoint of diplomacy, apparently from the perspective of knowledge about HPV, and perhaps from a technical medical perspective.

I can't say there is no chance you acquired a wart-causing HPV type, but with no warts so far, this is very unlikely any time in the future. But not something to lose sleep over either:  warts have sort of a "yuck" factor, but it's a minor medical problem, usually easily and quickly treated.

There is no way you will ever know where or from whom you acquired this or any other HPV strain you may have. And it doesn't matter at this point. Trying to work this out will only be stressful without benefit.

Finally, you can take your time if you decide to find a different gyn. You have many months of safe time before any further diagnosis or treatment could make even the slightest difference.


---
---
4 months ago
Thank you soooo much, Dr. Handsfield. You have been a godsend in this horrible ordeal. Your quick and thorough responses have given me so much peace. It doesn’t feel like my whole world is imploding anymore. Having said that, I still can’t shake this uneasiness, but I suppose only time will heal that. 

As a final follow-up, because clearly I have a doc who can’t give me sound advice/information, I have a quick question about transmission: If this HPV test came back positive because of a reactivation, I can assume it was an active infection right before or after they took the swab, right? If my husband had performed oral around that same time, is the virus potentially in his throat? Does that give him a higher chance of throat cancer now? If it’s in high throat, can he pass it to me through kissing? I’ve read some of your other posts, so I’m not sure it’s even been studied that closely and I know you said to just keep up with regular dental visits, the new information we have is just a little scary. Hearing the “C” word always sends chills down the spine, even if it isn’t a high, high risk.

And finally, this seems weird to ask at the same time as the above question, but can my husband and I expose this to our kids? If it is found on the skin of our genitals, are our towels breeding grounds for it? Our loofas? I have this disturbing thought that I’m going to transfer the virus (via loofa) to my breasts and my infant, who nurses, will contract it and then develop recurrent respiratory papillomas. I’m also afraid to bathe with them. Sometimes the quickest way to clean my kids is to hop in the tub and my husband kind of throws a kid in, I clean them, and then we trade. Now I’m concerned I shouldn’t do that either. 

Your advice and knowledge is greatly appreciated. 

I don’t have any replies left, but I really can’t tell you how thankful I am for your work in this field and for this service. I don’t know what inspired you to work in STD research  for 40+ years, but I’m glad something did.  It’s been, hands down, the best $25 I’ve ever spent. Last week I was preparing to pack my kids up and break up our family because I was so devastated by the diagnosis and bad “advice”  I received from my last doctor.  I still feel like I got punched in the gut after the conversation with him, but I hope that feeling will eventually go away. I will definitely be passing the info that you provided (and that is backed by the hundreds of legit websites I’ve visited over the last week) with people I love and care about. Thanks so much again. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
You can assume your husband has been repreatedly exposed to your HPV over the years, likely infected already, and maybe even the source of your current infection. You've only had maybe 5-10 paps in the last few years, but if you'd been tested for HPV daily, probably there would have been several positive results. That is, the apparent reactivation now is just the only one detected.

There's been a lot of media attention to pharyngeal (oral) cancer due to HPV, but it remains an uncommon cancer -- mushc less frequent than breast, prostate, colon, lymphoma, and many others. Assuming oral sex is among your sexual practices together, you and your husband could have oral infection. And oral sex isn't necessary:  the frequency of oral HPV is not closely linked to frequency of oral sex; many infections may result from auto-inoculation, i.e. self transfer of genital HPV to the oral cavity. Just as for genital infection, the vast majority of oral HPV infections remain silent and do not lead to cancer. Look at it this way:  around 10,000 cases of pharyngeal cancer caused by HPV are diagnosed per year in the US, compared with probably 20-50 million Americans who have been exposed orally to HPV 16, almost the only type that causes pharyngeal cancer. (And remember that your own current infection isn't type 16.)

HPV is never transmitted to household members despite years of sharing toilets, kitchens, towels and other personal items. Your kids are not at risk, whether from bathing together or anything else you can think of (not counting sexual abuse, of course). Your kids will get their own HPV infections when they become sexually active, but not until then. That day -- when your kids will start getting exposed to HIV -- isn't very far away, perhaps under 10 years. So a final word to the wise: make sure they are immunized against HPV as currently recommended, i.e. around age 11-12. The vaccine will reduce their chance of a serious outcome, i.e. genital warts or various cancers, by 90%. They will also be 90% less likely to go through the sort of experience you are having now.

Thanks for the thanks. I'm glad to have helped and that the forum has been useful. You might consider whether to make a donation to ASHA, the forum sponsor:  their work on behalf of sexual health is unexcelled, and there are easy links for donation at www.ashasexualhealth.org. Take care and stay safe!
---
---