Hello Doctors,

I am hoping for some help and guidance around HPV. I am a healthy 42 year old women, married for 17 years with 3 children. I believe our relationship is faithful/monogamous for this entire time as I have no reason to doubt otherwise (for certain reasons I can be 100% confident for at least the past 4 years he has been 100% faithful, but really have no question before then either). 

I recently had my annual exam which included PAP SMEAR WITH HPV. The results came back with a note that "the cells from your pap smear were normal, but your HPV virus test was positive, but not for the more concerning subtypes 16/178/45. So, the recommendation is for a rpt pap and HPV test in 1 yr with your annual."  I went back through my medical history and this looks to be the first time I have ever had the HPV test with my annual pap smear exam (at least from what I can tell from the reports). I have had no other symptoms of warts, lesions, or abnormal pap smear results. My husband has also had no warts or lesions in the long time that we have been together.

In previous yearly exams, the lab test titles only indicate Pap Smear but does not indicate "with HPV" as in this most recent test. There are a couple notes within the old results going back 10 years ago that I'm not sure what they mean but do reference HPV - "HPV on ASCUS Pap diagnosis, with genotyping." and another annual exam indicated "BCP; HPV HI reflex on ASCUS diagnosis only."

I have read through the forum about this topic and fully understand that HPV is the most common STI with 80-90% of the population having it at some point in their lifetime. I also understand that most individuals clear HPV in 1-2 years. However, this doesn't stop me from having some anxiety and concern over the topic, especially with being married and in a long term relationship with someone who I love greatly.

I do have a request in to my Doctor to discuss my questions and concerns, but I also wanted to reach out to you as I know this team is the experts on these topics (also coming from the medical field in the PAC NW)  and hopefully help gather my thoughts as I anticipate it to be a bit of a stressful and emotional discussion for me with my Doctor.

I have a couple questions below, so I hope this is acceptable as I understand the process is for 1 question with 2 follow-up questions. Happy to break this out into multiple requests if that is more appropriate.

1) I do truly believe the relationship is faithful, but this has clearly created some questions and stress in the relationship (for both of us I'm sure). As young adults we both were sexually active before meeting each other. Is it really possible that I have had HPV this entire time?

2) If I have had it for a decade or two, would I not have tested positive before during an annual exam or during one of my pregnancies? I am not sure how/when HPV is generally tested. I have read that some recent guidance/changes in the testing of cervical cancer has only recently started doing HPV testing with pap smears? In addition, I have read that it can lay dormant for a lifetime and can really show up at anytime or even have a reoccurrence, but I'm not sure if this is true.

3) Again, if I have had this for years and the virus has not cleared itself as it typically does, is there an increased risk that this is/will develop into cancer?

4) Is it possible that the virus will still clear it self at some point?

5) I assume there is no/little risk to my husband as we have been married for 17 years and he either passed it on to me or I passed it on to him, but just want to confirm.

6) Is there anything you would recommend that I should my Doctor during my visit?

Thank you for your help.

Your situation is very common:  it would not surprise me if a million women per year experience it in the US alone, not to mention millions more world wide. At your age, the large majority of abnormal Pap smears (or positive HPV testing at the time of the Pap smear) are experiencing what you are:  detection of an infection acquired many years previously. When you discuss further with your gynecologist, you probably will find that s/he has managed many patients in essentially the same situation.

The words you quote from past Pap smears seem to indicate that HPV testing was done (because the pap showed "atypical squamous cells of undetermined significance", i.e. ASCUS) -- but not the results of the test. Presumably those HPV tests were negative or you would have been informed by your doctor(s).

To your numbered questions:

1) It is not only possible, but highly probable that you acquired HPV (probably several times!) from your sexual partnerships before linking up with your husband. At least 50% of people acquire one or more genital HPV infections during their first three sexual relationships, and 90% of all people are infected at least once.

2) The immune system typically suppresses HPV to a point that standard test methods (DNA testing) cannot detect it. However, DNA may nonetheless persist and infection reactivate years later. Your own statement is exactly true, i.e. HPV "can lay dormant for a lifetime" and then reactivate and be detected.

3) Risk of cancer depends far more on the specific type(s) of HPV someone has than on recurrence. That no abnormal cells were detected on your recent Pap smear is strong evidence that you are at little or no risk of cervical cancer. This too is something to discuss when you next meet with your gyn.

4) Probably future HPV tests will again be negative. You could ask your gyn about not waiting a year for a repeat test. It could become negative in the next couple of months.

5) Correct. You can safely assume your husband has been infected with the same HPV strain you have; or if not infected by now, not likely to catch in the future. Like all people with a pre-marital sex life, you (and he) can safely assume he has had his own share of HPV infections. No precautions against transmission from you to him are necessary -- i.e. no need to modify your ongoing sexual habits and practices. Whatever gives you mutual pleasure is OK and will not put him at risk of a future HPV problem of his own.

6) I think you've covered the main questions to ask your doctor, along with the suggestions implied by my answers above.

I hope these comments are helpful. Let me know if anything isn't clear -- but I might suggest you hold off until you have also spoken with your gyn. For that visit, you might consider printing out this discussion and see how her or his responses compare with mine. I'm betting they'll be pretty similar.

Best wishes--   HHH, MD