[Question #8781] Positive HPV test/Normal Pap 6 years after clearance

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40 months ago
Hello,

I am really confused by my most recent HPV test. when I was 29 I had HPV (Genotype 59) in 2015 with CIN1, by the end of 2016 I had a negative test and normal pap and have been getting negative tests and normal pap every year since. I am 35 now and my most recent test showed HPV positive and normal pap. I have been with the same partner this entire time, married now. I am sure he did not cheat on me.

I am healthy, don't smoke, am never on birth control, and just drink on occasions. only had 2 partners before my husband one of which was not consensual. My husband as only had 3 partners prior to me. 

 I have been told stress can reactive the virus but I know people with autoimmune problems that never reactivated their virus. The only difference is that this year I got tested with Cobas DNA test and in prior years I have been tested with Aptima. I read that Aptima is not as sensitive and I am wondering if maybe I've never cleared the virus or this Cobas test is detecting my old infection at low levels? This year I got the COVID vaccine and caught COVID, had it for about 3 weeks in late December, and had mild symptoms but they just didn't go away for a while. I am wondering if there could be any link between catching covid and HPV shedding/reappearing or something like that? Gyno said to re-test in a year didn't seem concerned but I was hoping to start trying to get pregnant in a year and I am worried that I am going to fluctuate from positive to negative throughout my entire life. I am concerned because everywhere I read it says the virus clears in 2 years etc and only persistent infections lead to problems. 

Both my husband and I are not vaccinated for HPV, but we want to get it asap. 

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Edward W. Hook M.D.
40 months ago
Welcome to our forum. Thanks for your questions. Understanding the coming and going of HPV can be quite challenging. In most persons who have HPV infection, without therapy those infections resolve and, if abnormal before, Pap smears become normal. Recently, careful scientific studies using sophisticated research tools have showed that the HPV virus DNA can still be detected in a portion of persons in whom detectable HPV infection has resolved. In those persons a small proportion then go on to periodically reactivate their infections. This may well be what happened to you. 

Alternatively, use of a different test may have detected HPV which was present but went undetected with your earlier tests. Irrespective, the fact that your Pap smear is normal is good news and bodes well for you.  My recommendation is simply to continue to get regular Pap smear and HPV test and follow up. This is not something to worry about.

Presuming that you and your husband are involved in a monogamous relationship and do not anticipate having other partners, the benefits of HPV infection vaccination is debatable. Any HPV infection which you or your husband may have  been repeatedly exposed to the other. There are limited data which suggest that HPV vaccination may enhance resolution of existing infections but those data are those the facts are subtle and modest.  There is certainly no harm with getting vaccinated for HPV but, as described, the benefit may be modest if any

I hope this information is helpful to you. It is a complicated and continually involving issue. If there are further questions or any part of my response is unclear, please don’t hesitate to use you were up to two follow-ups for clarification. EWH
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40 months ago
Thank you Dr. Hook , this information was very helpful. My only concern is clarification on " use of a different test may have detected HPV which was present but went undetected with your earlier tests." Are you saying there's a possibility I may have been HPV positive all these years and only now detected with the Cobas DNA test? I know my paps have been clear all these years but I did read a study that 30% of paps are inaccurate and co-testing can cause false results.  
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Edward W. Hook M.D.
40 months ago
That’s a great question. You are correct that about 30% of Pap smear abnormalities are missed with a single Pap smear test. Fortunately Pap smear abnormalities progressed so slowly that with regular repeating abnormalities are virtually almost always found before they can progressed to cause problems.(I.e a single PAP smear may miss 30% of abnormalities but the next time a PAP was performed, the 2nd test would detect 70% of the abnormalities missed the second time, and so on).  The sensitivity of HPV tests is better than PAP smears but different tests have different (albeit higher than for Pap) sensitivities.  While I doubt that you have had HPV which was missed, I cannot dismiss that possibility entirely.

Hope this helps.  EWH 
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40 months ago
Thank you so much for your answer it does help and I will just have to wait until my yearly check up to make sure that everything is ok - have a great day!