[Question #7680] Future outlook

2 months ago
I've had 25 annual paps and all have been normal, except 1.  Had CIN 2 removed and all paps have been normal since.  That was 17 years ago and hpv has been negative every year since then too.    My husband and I have been married and monogamous for 26 years.     My questions are as follows:.  
1. Since my abnormal pap did not occur until my 30s, does that mean I had a persistent infection ?     I had all normal paps in my 20s. How long does it take for changes to show up on the pap?  We were married since our 20s  and always faithful. 

2. Since my paps are normal and hpv always negative,  what do you think my future outlook is concerning any possible changes? They did not type the CIN years ago.  After the CIN was removed, I had 2 paps 6 weeks later.   A gyno told me I must not have had hpv because there would have been at least a trace after the procedure.   The paps were completely normal and hpv negative. 

3.  Been stressed.  I'm usually not.  Do you think this could  bring back an abnormal pap?
 
4.  I know HPV can impact other areas of the body.  Do you think everyone who has had an abnormal pap will eventually have a problem in one of those other areas?  Especially since my abnormal pap was in my 30s? 

5. Have you seen menopause bring back original infections? What do you think the probability of that happening is? 

6.. I have always been a very healthy person... barely a cold.. if I would have been infected in my 20s , why did it progress to an abnormal pap so many years later.  

7.  If the pap goes from normal to abnormal within a year, does that mean the hpv just activated with

8. What if a person had a child while the pap was normal but maybe the HPV was still there?  Could a virus be laying silent and they'll have a problem as the child gets older? 

I look forward to hearing from Dr. Handfield or Dr. Hook. Any insight you can provide, I'd really appreciate. I know you are the subject experts!!  Hadn't thought about this in years, just got a little scared . Thank you


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
2 months ago
Welcome to the forum. Thanks for your confidence in our services. I'll go directly to your questions.

1. As you apparently know, HPV infections often persist for years, perhaps for life, and can reactivate to cause an abnormal Pap smear or other symptomatic issues like genital warts, or to be transmitted to the partner. Most likely your cervical dysplasia (CIN2) was the result of an infection acquired years earlier and reactivating. However, it's also conceivable your husband had an asymptomatic reactivation of a past infection and you were newly infected from him. I suspect the first scenario is most likely, but there's no way to know with certainty -- and at this point, it probably doesn't matter.

2. I disagree with your gyn's comment about HPV still being detectable after resolution of dysplasia. All cervical dysplasia is caused by HPV; there are few if any exceptions. Most HPV infections become undetectable over time and cannot be detected by even the most sensitive tests. Subsequent recurrences are generally rare:  there is little risk you'll have yet another reactivation or any future abnormal Pap smears.

3. Many people including experts believe stress, poor sleep, etc can adversely affect immune function. However, the weight of professional opinion is against it. Certainly there are no data to suggest higher rates of HPV reactivation in stressed or anxious versus unstressed, mellow personalities.

4. No. The large majority of HPV infections are localized to one area. There is little chance your past (or current, inactive) HPV infection exists elsewhere.

5. To my knowledge, menopause is not associated with reactivated HPV or recurrent dysplasia. If anything, the opposite seems true:  abnormal Paps become increasingly uncommon with age, which is why Paps are not recommended after age ~50 and/or several years of negative Pap smears. 

6. There are no known triggers for HPV reactivation or development of dysplasia. It appears to be random. The only factor that might be related is cigaret smoking:  smokers have higher frequencies of dysplasia and perhaps more frequent progression toward cancer. However, I am unaware of data that smoking influences HPV reactivation itself.

7. Incomplete question, but I think you're asking if it means HPV has reactivated. Yes, for the reasons implied in my replies above.

8. Genital HPV sometimes shows up in young people who have not been sexually active. Acquisition from maternal infection at birth is among the explanations people have described. However, it is pure speculation:  there are no data to indicate that children born to HPV infected months have any higher frequency of HPV as adults. A much more likely explanation is that people often give inaccurate sexual histories, denying sex for social or stigma reasons; or not remembering events such as sex while intoxicated, repressing memories of sexual abuse, and so on.

The bottom line is that there really is no basis for being "a little scared" at this point in time. The odds are strong you'll never have another hint of your past HPV infection or abnormal Pap smear. I hope this discussion helps you move on without worry! Let me know if anything isn't clear.

HHH, MC
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2 months ago
THANK YOU so much Dr. Handsfield.  I was so happy when I saw you were assigned my questions.  I am really hoping you can answer these next ones since I was lucky to get you! I am ONLY interested in your opinion.  I like how you present your facts and opinions.  I can wait until you have time to respond. 
Yes, I didn't complete that one question.  I meant to ask if the HPV would reactivate, how long does it usually take to show changes on pap?  Years ago when the pap was abnormal, the prior year it was normal.  Does that mean the hpv reactivated within the year ?  This also means I didn't fight it off within 2 years until after the dysplasia was treated?  Any insight would be appreciated.
If hpv type 6 or 11 was present, would I know by now?

My son is studying biology/premed.  I sometimes look at his textbooks.  Jumping topics here . I am going to ask all of my questions since I really trust your opinion. I've read alot of your prior work and I know you're an expert. 
 Is it true that HSV 1 and 2 can lay dormant for decades?  About 26 years ago, I had what I thought was reoccurring UTI burning/itching on and off for about a year. I had never had it before. It finally went away and never thought about it.  I had also had some thicker clear discharge with slight smell.  Thought it was ovulation?  Wish I would have had it checked because I'll never know.  I didn't do a visual because I didn't think to do so. If it would have been HSV, wouldn't I have had other symptoms or outbreaks by now?  Read that outbreaks do not always have blisters? Maybe they disappear that quickly?  
1. How many outbreaks would one expect during 30 years? Could someone just have one and not have any and then have bad ones during menopause or when they're elderly? Do people get totally surprised out of the blue?   Is that normal? 

2. Wouldn't something have showed up during 3 pregnancies?
3. Can HSV just cause joint pain, sciatica, neurological issues and no other typical symptoms?  A few years ago, the bottoms of my feet had pins and needles in them for about a day.  It hurt to walk.  There was one other time, my ankles were stiff when I woke up . Hurt to walk up steps. I am fit and this was not normal.  I didn't have any other symptoms ? Could that be an outbreak? 

4. Read that hsv can move down nerves and occur anywhere on the body even feet.
5. Since I'm probably in Perimenopause, I sometimes have a little minor sensitivity in the area before period. I guess that's normal. Could hsv just live in the tissue and never abrupt into lesions ? 

6. Alot of articles say a person can have very minor twinges, etc.  for just 10 minutes and that's a prodome? Really? 
I guess I'm just curious what you've seen in your studies and work.    Anything to be concerned about?   Maybe you could go through each question and give your insight to each question? I know they may be silly but I have to ask.    

7. I have felt completely normal down there except for that one year 26 years ago. My husband has always felt normal.  No bumps or pimples on his area below...EVER.   There was one time he had what appeared to be a pimple.  For 2 weeks, it didn't change.  He put anti fungal cream on it and it disappeared the 3rd week.  It appeared 2 days after intercourse so of course I connect the 2 events. Thoughts? 
  If you had to give a percentage or a gut feeling if you think any of this is concerning, can you let me know?  Thank you for your patience.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
2 months ago
Thank you for your respectful comments. However, the follow-up question opportunities are intended for clarification of the initial question. For your new herpes issues, please post a new question, which will be answered by Terri Warren.

Timing of HPV reactivation etc:  The answers really aren't known; I can't say the intervals between, say, ractivation of HPV (as documented by DNA testing) and when cellular changes (dysplasia, abnormal pap smears) might develop. Often these are simultaneous events, but perhaps not always. Also, I am unaware of data on the speed with which HPV reactivation is suppressed by the immune system. For newly acquired HPV, the DNA tests remain positive for anywhere from a couple of months to two years or more (longer for the high-risk (cancer causing) types than low-risk versions. Whether or not different for reactivation, as opposed to initial infection, I cannot say; I'm not aware of any studies on this. Sorry.

Quickly glancing at your HSV-related questions, I doubt you have genital herpes. Your distant past problem with genital itching, burning, etc is more suggestive of a vaginal yeast infection; or perhaps some other local irritation, e.g. reaction to a vaginal hygiene product, spermicide, latex (condoms), and so on. But not herpes. And none of the other various symptoms you mention are typical of herpes. For example, it is an internet/urban myth that herpes can explain scietica-like symptoms, or genital "tingling" while never having an overt herpes outbreak. However, if these concerns continue -- perhaps after another thread with Terri -- you and/or your husband could have a blood test for HSV1 and 2 antibodies. 
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2 months ago
I tried sending this before.  It didn't show up with the other threads so I'm resending. 
Dear Dr. Handsfield, thank you SO much for answering my questions! You really made me feel better. You are great at what you do. I thought I wanted to learn more about science but I think I'll quit reading textbooks and internet for awhile.  There can be scary stories. My husband and I do not have any risk factors, yet one story can send one researching. 
I do not have any new questions. Your opinion is all I needed to hear. Before I put this week of unnecessary worry behind me, can I please ask the answer to my final 2 questions?
For question#7 in my second thread, do you think there are any associations with the bad pap from years ago? Is it normal for a man to just get a pimple once there? This has never happened before.  It stayed for 2 weeks.  No itching,etc.  When he put antifungal cream week 3, it disappeared .  Therefore not viral? 
For my final ? When you said it is unlikely to have HSV, can you tell me why? Is it because a person would have probably had a few noticable occurrences at least every decade? I'll even take a yes or no answer ☺️.  Not looking for a big answer. When I read a person didn't know they had it until age 65, I thought that must be wrong or atypical. 
Thank you again! I truly appreciate you looking at my ridiculous questions. Not even sure why I sent them since my spouse and I have been together for years, been faithful, and have only had unprotected intercourse with each other.   I think my logic is off a little.  Just recently, I had a lifelong friend die from cancer (only had it a year) . Then another friend had covid very bad.  It's those moments that make you grateful for everything and realize how fast life can change.  Thank you again and God Bless
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
2 months ago
HPV cannot cause pimples or make them more likely or more frequent. Your husband's genital pimple had nothing to do with HPV.

All I said and meant is that the symptoms you describe are not typical for genital herpes and I doubt you had it then or now. See my prior advice about perhaps posting a new question about your herpes concerns, and/or the possibility of a blood test.

I understand and agree that being confronted with friends or relatives with cancer, and the entire situation we all live with eventually -- aging and confronting our mortality -- can be stressful. But there is nothing in your history that suggests a high risk of cancer due to HPV.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes -- and try to stop worrying about herpes or HPV. They are nothing-burgers with respect to your life and health!
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Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
2 months ago
Good morning, Dr. Handsfield asked me to take a look at the parts of your post that deal with herpes questions.  I would agree that herpes seems unlikely in your situation, based on your description.  While it is true that many people can have herpes and not know for many years, what you describe just doesn't fit well with someone I would be concerned about in this regard.
If this continues to be a worry for you, you can obtain a herpes western blot antibody test, the best and most accurate blood test to know if you have HSV 1 or HSV 2 or neither or both.  It is done only at the University of Washington, but you can order a kit from them to do the test and work with your own provider to get the blood drawn and spun or work with me at westoverheights.com.
Having said all of that, I would ask you to think carefully about what you would do with a positive result if you got one.  Nothing you've described has interfered with your life, in terms of possible herpes symptoms.  What would a positive result mean for you and your relationships?  If you were my patient, I would ask you to think very carefully before pursuing testing for HSV. 

Terri Warren

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