[Question #7554] Normal Pap, but positive for HPV, negative for high risk HPV

2 months ago
Hello, 

I am a 30 year old female. At the end of September 2020, I got an HPV test done with my annual pap. 

The pap came back normal, but positive for HPV. They tested for the 14 high risk types and it was negative for those. I missed this test result because I just saw that my pap came back normal and didn't see the HPV test. I was informed today about the HPV result when I went to the doctor in person.

I received all doses of my HPV vaccine in 2015/16. 

Today I went to the doctor because I found two very small warts. The nurse was surprised I even noticed them. I have no idea when they appeared. I noticed them a couple days ago. The doctor did not notice anything back in September during my annual. 

In early September, I slept with someone two times. Once unprotected and once protected. 

Should I inform this person of anything? 

I have let my current monogamous partner know so that he can keep a lookout for any symptoms. 
Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago

Welcome to our Forum and thanks for your questions.  I'll be glad to comment.  Congratulations on having received the vaccine which will certainly reduce your risk for acquisition of future HPV infection.

There are well over 100 different types of HPV.  Over 80% of unvaccinated, sexually active persons will acquire one or more HPV infections at some point with the first infection typically occurring within a year or two of becoming sexually active.  The HPV vaccine, depending on which one you got provides over 95% protection from the two HPV types which cause most visible genital warts and either the two or seven HPV  types which most commonly cause most pre-cancerous PAP smear changes.  It is not at all uncommon for a woman to have acquired an HPV type which was not covered by the vaccine but fortunately, the risk of such infections proceeding to pre-cancerous lesions is even lower than for the vaccine types.   You are unlikely to ever know when you got the HPV that showed up in your PAP smear.  In some instances, HPV infections which have been suppressed by the immune system transiently reactivate and are detected on PAP smears.  This is not a cause for concern and does not mean that your positive test is a threat to your health.  Given what you describe, the way forward is to simply continue to have your regularly scheduled reproductive health checks/PAP smears.

The warts you noticed recently may or may not have been missed with prior exams so as noted above, you are unlikely to know where or when your infection occurred.

As for partner notification, we do not feel strongly that persons with HPV infection need to disclose the fact of their diagnosis to prior partners, nor do they need to take special precautions to prevent future transmission.  As noted above, whether they know it or not, most sexually active persons, including your current partner have already acquired HPV.   

I hope this information is helpful.  Questions about HPV, disclosure, and the significance of positive tests are among the mst common questions we receive on the Forum.  I would encourage you to look at other threads on the site- we keep them available so others can see what the information we provide.

If any part of this is unclear.  Please don't hesitate to use your up to 2 follow-ups for clarification.  EWH

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2 months ago
Thank you. 

I am feeling some guilt because I had a colposcopy done in 2019 that came back as LGSIL. Nothing was said to me besides saying they would do another check up in a year, which is when I got the positive HPV test and negative pap. There wasn't a discussion about transmission or anything. I did not disclose my LGSIL to partners because I didn't have an HPV test done at that time. Furthermore, I figured if it happened to be HPV, it was something everyone had and I did not have warts. It didn't seem like something to be shared. Going forward, if that happens again and I'm no longer with my current partner I will inform people. I spoke with my doctor in September 2020 about my guilt and concern and she agreed with me that it was okay. But I am still feeling bad about my actions. 
Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago
While I understand and sympathize with the guilt you are experiencing and take it as a suggestion that you are a thoughtful, caring person.  That does not mean or suggest you are at fault here.  Please do your best to not beat yourself up over this. EWH ---