[Question #7720] Questions

29 days ago
I'm sorry to ask another question, but I would like to ask them while thinking about them. Can you please look at my prior closed question that Dr. Handsfield answered? 

I am concerned that HPV or another virus (cold sore) could be causing liver infection. About 4 years ago, I had the following numbers on routine bloodwork.

March ALT 13. (0-55).  AST 14 (5-34).
April ALT 27 (10-52)     AST 55 (14-40)
Was told I didn't need to fast so I think that's why it was high?
May ALT 23 (0-32).  AST 39 (0-40)
June ALT 24 (10-52) AST 20 (14-40)

So there was that one time AST was high and another on high end of normal.  I'm worried a virus could be causing a slow destruction to my liver?   Would the numbers fluctuate like this ?   
I do not drink and tested negative for all hepatitis viruses.  
The only reason I had this much bloodwork because my lymphocytes and neutrophils were weird on the first test.  They were
Lymphocytes 20 (22-44)
Neutrophils. 69 ( 40-70).  They stayed like this 2 times.  Also read that viruses (hpv and hsv) can impact these numbers.   Thoughts?

I read in someone else's post that hpv that causes cell changes can also cause warts. Have never had them. Please see my prior question about spouses pimples.  Probably still a pimple based on what I discussed in last question.

When you told me not to worry about another abnormal pap is that because removing the cells (even in 30s) that usually prevents future new problems from the same old infection?  It's been 15 years. Would it have already occured in other vaginal areas if it was going to? Always been hpv negative on paps too.   My first child born 4 years before bad pap.  I still worry hpv could have went in baby's mouth and will have tonsil cancer later on.  Pap was normal during pregnancy so was hpv not active?  
If you could give me your input I'd greatly appreciate it

29 days ago
I wanted to clarify I have not had another abnormal pap.   I only had that one 15 years ago.  I just get concerned because I was in my 30s which means I didn't fight it off like most people do.  You and most articles say treatment of the cells is usually successful and prevents future occurrences.  Is that for even these situations.  Paps and hpv always been negative.  
One of my 3 children had a little jaundice a few hours after birth.  It resolved in about 3 hours and never returned.  No one seemed upset at the hospital.  Was released after a day so assuming no problems.  I never mentioned abnormal pap because cells were already removed about 1.5 years before and pap was normal during pregnancy.   Never even thought of hsv until a few weeks ago. The only reason I thought about it now is because it said that jaundice right after birth is suspicious of possible infection.  If jaundice occurs after 24 hours that's more normal jaundice.  So again, could a virus have impacted baby long term?     
If you honestly think this could be possibility , please let me know.  
I know nothing can be done to change the past, but I'm just curious what you think about all of this?
Do you think any of this is related or reason for concern?  Do you think I still have nothing to worry about and hpv or hsv are not going to impact any of our futures?  I have never had outbreaks so I still believe what you think about never having hsv.
--do you hear people have lots of bad paps in other vaginal areas years later? 
--do you hear about people having liver failure due to constant attack by either of these viruses? Takes them by surprise
  I ran out of room in my prior question and really wanted you to know this information.  I wasn't planning on writing to Terri a few weeks ago so that took up one of my other questions.  This will definitely be my last question!!   I really want to forget about any of these last remaining concerns and hope you can help. Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
29 days ago
Welcome back to the Forum.  As you may know, Dr. Handsfield and I share the Forum for replying to STI-related questions while Terri handles questions about herpes - now you will have heard form us all. The reason that Dr. Handsfield work together is that in the more than 35 years we have worked together, while our verbal styles vary, the facts, substances, and our opinions on risk and infection have always agreed.  On this occasion I happened to pick up your question.  In preparing to reply, I have looked at your earlier interaction with Dr. Handsfield and agree with all that he said.  I'll go directly to your questions:

Your liver tests. With the solitary exception of your test of an AST that was minimally elevated in April, your tests have been normal.  When persons have viral liver infections their liver function test values are typically in the thousands.  Minor, isolated low level elevations are common and typically of no consequence.  These tests can be elevated with transient mild viral infection, with vigorous exercise or a host of other reasons.  They tend to fluctuate from day to day and values that are at the upper range of normal are still normal.  I see absolutely no reason for concern related to your liver tests.

Just as liver tests fluctuate on a daily basis, so do white blood cell counts and their distribution (i.e. the proportion of neutrophils, lymphocytes and other types of cells). Once again, I see nothing whatsoever of concern here.

You are correct that HPV can cause visible warts.  Warts however are somewhat firm, raised groups of cells. In contrast, as Terri mentioned earlier, pimples and pustules are fluid-filled lesions that break open and then heal or just go away on their own over a relatively short time period while warts persist for months or longer.  What you describe as pimples sound nothing like warts.  

Well over 50% of women who deliver their children vaginally have HPV yet oral infections are extraordinarily rare.  I really would not be worried about this.

Finally, I find myself wondering what has recently caused your concern of late.  Further I wonder if you have been looking for information on the internet. If you have been using the internet for this purpose, I urge you to stop.  The internet is loaded with misinformation and it is very difficult to determine what is true and what is wring.  So much of what is there is taken out of context, misinterpreted, out of date or just plain wrong, representing folk tails and urban myths.  

I hope this additional information is helpful.  EWH
29 days ago
I think I sent you my second set of questions while you were writing your response to my first questions.  Would you mind answering my second set and these final ones? *Especially the one about how jaundice on the same day of birth is bad and probably means viral infection?  It's better to have normal jaundice begin on 2nd day?  
1. Could my children have one of the viruses I've mentioned in my ? and them not develop outbreaks or cancer until early adulthood?    Aquire at birth?
2. One of my children had a swollen neck nodule for maybe 6 months about 13 years ago.  It disappeared but could child been fighting off one of these virus?  My pap was normal during pregnancy. Bad pap occured 4 years later.
3. Do you think adults with oral cancer acquire it at birth if it was a long delivery?
4. I know Dr. H thinks I will probably never have another pap occurrence since it has been so long.  Why is that? Once the cells are removed does this make hpv go dormant or lose strength?  Why did it occur even the first time? 
5. Since hpv negative, would it have already occured in other vaginal areas if it was going to?  Since I had moderate, is it very likely to end up other places.
6. Do you think I shouldn't worry because there is nothing that can change the past or because most people REALLY don't continue to have problems?
7. My husband has a quarter size fungus spot on upper thigh. Dr. said.  It's been there for almost a year.  Just a little red and little rough.. There have never been blisters.  Would any virus I mentioned last a year? Could this explain the 2 pimples.
8.You said you agree with Terri.  Do you think I would have had at least 1 classic outbreak each year or decade if was hsv? 
9. In my prior question, I mention a bright red streak on my husband's leg.  Could this be a weird OB?
10.  If my AST number fluctuates in the future, what would be a number I should worry about?   Can these viruses slowly destroy liver and cause failure in 10/20 years? Maybe I'm seeing the beginning of it?
11. What is a transient viral infection...these virus could be flaring?
12.  Do you think I am going to have constant HPV problems with any of this I mentioned or do you think I just got scared. What about my family?  Can stress bring back abnormal pap. I'm usually mellow so concerned stress can bring it back.  I appreciate your input and can you answer each question. I'd really appreciate it!!  

Edward W. Hook M.D.
Edward W. Hook M.D.
28 days ago
Jaundice in newborns is rarely a manifestation of infection of any sort.  It occurs because the liver may not be fully mature. In response to your many questions, adding the caveat that this thread is dedicated to sexually transmitted infections and there is no evidence from what I have read in this and your earlier posts  that you (or your children) have an STI at this time.  I worry that you are worrying unnecessarily and may have gone down a "rabbit hole":

2. I cannot identify the cause of the "nodule" you describe as having occurred and resolved in your child 13 years ago.  It certainly sounds nothing like something that is HPV-related.   It is also most unlikely that it was a manifestation of any STI.
3.  No, First, not all oral cancer is due to HPV and when it is, it likely reflects an HPV infection associated with performing oral sex on an infected persons. Most persons who perform oral sex on an HPV infected partner do NOT get HPV.
4.  When PAP smear abnormalities resolve and HPV is undetectable it is because a persons immune system has suppressed the infection.  
5.  HPV infections can occur in multiple places but if you have had repeated normal exams, this is not something to worry about.
6. Both statements are true.
7. Fungal infections are not viral infections and are treated differently.  Your husband should discuss this with his doctor if he wishes it treated.  Fungal infections can occasionally appear as pimples but there is simply no realistic way to determine whether the blisters you noted were due to a fungus.  
8.  Yes
9.  No, this is not suggestive of herpes.
10.  This should be discussed with your doctor but I cannot why you would be repeatedly checking your AST unless there was some observable abnormality which led your doctor to suggest is based on her/his assessment of you.
11.  Transient means self-limited.  Colds are transient viral infections.
12.  No, no no.  I think you are worrying unnecessarily.

Hope this helps. EWH

27 days ago
The reason I was concerned about the neck nodule is because I thought maybe my child could have gotten hpv in the birth canal and in the throat.  Since the neck is nearby, perhaps the lymph node enlarged and was trying to fight infection.  Thoughts?

As for the ALT and AST numbers, what if I would have another AST reading that was either at the high end of normal or let's say it would be 60 or 70  (out of range) next time.  Could that be a persistent viral infection slowly destroying the liver (either hsv or hpv).   

Could I have had a primary hsv outbreak years ago and it damaged the liver back then and now seeing it on bloodwork?

Can stress or lack of sleep cause weird alt and ast numbers?  I read that people can have normal ast and alt numbers even while the liver is being destroyed by viruses?  True?

I have always been healthy.  I'm just thinking a virus must be impacting those numbers sometimes.   Thought?

Over 2 and a half decades ago, I had that itching and burning that seemed to come and go for about a year.   What if there were blisters and I missed them?  Wouldn't I have had other outbreaks throughout the years?  Or do you think I just have a strong immune system but eventually I'll have outbreaks when I get older?    

What if all the outbreaks were internal and I never knew all these years?

Do you hear of people that just totally missed the hsv and then 30 years later it returns very badly by surprise? 

Can people just feel completely normal and then tons of outbreaks after menopause? Would I have known if I had 2-4 outbreaks a year?  

When you say the immune system suppresses the hpv...does that mean forever? Many stories say people usually don't have recurrences?

What I'm trying to understand is how can people not be able to fight it off in their 20s (bad pap in 30s)...but after the dysplasia is burned it usually doesn't return? 

I keep thinking what if I was coinfected with both viruses and that's why the bad pap appeared in 30s?

It just seems like if a person had both of these viruses, they will ultimately have problems with either of them all their life?

A few years before my bad pap, I remember having some days where it seemed like I had more clear mucous than usual.  Could that be from the hpv and bad pap .  What about HSV?

Do you think I'm more at risk of getting cancer in another vaginal area since had that dysplasia years ago?
Thank you for answering each of these final questions.

Edward W. Hook M.D.
Edward W. Hook M.D.
26 days ago
Sigh.  As I have said earlier the chances of your child having acquired HPV at the time of delivery are far lower than your chance of being struck by lightening.  Further, HPV would not cause the sort of nodule you describe.  As I also said before, I think you are overthinking all of this.  

ASTs.  Normal is normal.  Again, I think you are focusing on a single marginally abnormal test far more than you need to.  HPV does not effect the liver, HSV infection of the liver is very rare.  There is no evidence you have ANY problem with your liver.

Could you have had HSV before.  As noted before, your questions on HSV should go to Terri but I note that she said NEITHER you nor your husband have had anything suggested that suggests herpes.  

Lack of sleep has many non-specific effects.  Your AST and ALT have been repeatedly normal however. If your liver was being destroyed, your tests would show it. They do not.

Itching and burning.  Repetitive.  There is no evidence that you have herpes which you have missed.

Typically, when HPV resolves it stays resolved. As you point out, recurrences are uncommon, particularly after years of negative tests.

No I do not hear of people who suddenly have several recurrent herpes after years of no problems.  

No I do not think you are at risk for further problems because of your abnormal  PAP years ago.

As you know, this will be my final reply. Further, in that your questions are in some cases repetitive and seem to focus on possibilities that there is no evidence to support, I must warn you that should you return to the Forum, your question may be deleted without a response and without return of your posting fee.  My sense is that your concerns have no basis that you have described to us.  If you cannot move forward without continuing concern which is what I sincerely hope you will do, my sincere advice is to discuss this with your own doctor.  It appears that you are worrying unnecessarily. 

I hope the information I and my colleagues have provided has been helpful.  Take care.   EWH