[Question #9279] HPV reactivation

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34 months ago
I would like to more about the statistics of previous HPV reactivating. I was diagnosed with high risk HPV (either type 16 or 18) about 15 years ago. I had a LEEP procedure to remove abnormal cells from my cervix. I have had normal Pap smears and negative HPV tests since then every year. I am wondering what the likelihood is that my HPV will reactivate. I’ve read women going through menopause can have this happen, and I was also just diagnosed with early menopause. What are the chances it will return? Are yearly Pap smears enough to catch this before it turns into cancer? Thank you.
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Edward W. Hook M.D.
34 months ago
Welcome to the Forum and thanks for your question.  I'll be glad to comment although I'm afraid precise answers are not available.  

High quality scientific studies have shown that after resolution of readily detectable HPV (either due to treatment or as part of the natural course of the infection) there may be residual HPV DNA present in tissue when studied by special research tools.  In some instances, but not all, this residual DNA may become detectable again after being non-detectable.  As a generalization, the longer the interval since the initial infection became non-detectable, the less likely it will recur and be detectable in the future.  In your specific case, your treatment sought to remove the infected tissue and the fact that there has not been a detectable recurrence in the past 15 years makes it unlikely that it will recur in the future.  Your risk of developing cancer are very, very low and should it return, your regular PAP smears should detect it early, allowing management.

Sorry there are not precise percentages I can provide you but hope this reply will be helpful.  Your chances of recurrence are very, very low and you are doing the right thing in terms of ongoing management.  I see no reason for other testing than what you indicate you are already doing.  EWH
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33 months ago
Thank you. I’d like to ask about my risk of oral cancer as well. I think I was exposed about 15 years ago to high risk hpv, and now I am concerned about developing oral cancer. Since my body did not seem to clear the HPV without a leep procedure, does this make me higher risk? What can I do to monitor this? 
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Edward W. Hook M.D.
33 months ago
There are no data to suggest that HPV requiring LEEP for management is associated with increased risk for oral cancer.  The risk for oral cancer from oral sex is very low and most infections appear to clear over time.  The best thing a person can do to reduce risk for oral cancer is to see their dentist regularly as dentists now visually check for abnormalities and, if a smoker, stop smoking.  EWH---
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33 months ago
Thank you. I was wondering whether the LEEP helped to clear my HPV, or just cleared the cervical dysplasia? Given that there is no parallel procedure to remove oral lesions/dysplasia, is it safe to assume my body would be able to clear the virus and/or any abnormal cells naturally, without intervention? I am wondering in the event I did have cell changes due to hpv whether it is common for the body to clear those lesions without management orally. I have read it takes 15 years for oral cancer to occur, and I am about that many years out since contracting hpv. I got the vaccine after my infection but I’m not sure that would help, I don’t smoke, and plan to see a dentist twice per year and ENT every other year but this is still causing a lot of anxiety for me. Thanks again .
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Edward W. Hook M.D.
33 months ago
Yes, LEEP is roughly equivalent to surgical excision in removing HPV.  It may well have removed you infection entirely.  

Regarding oral infection, it would assume all is OK unless you begin to experience persistent hoarseness, at which time I would ask your doctor to evaluate.  Otherwise regular dental exams and not smoking are the best practice for dealing with the VERY low risk of oral cancer.  The vast majority of people clear their oral HPV without therapy.  Limited data suggest that even with established infections the vaccine may help as well.

Give your plans for regular dental care and as a non-smoker I would really not worry.  

We provide up to three responses for each client's questions.  This is my 3rd response.  Thus this thread will be closed shortly.  Take care, please don't worry.  EWH
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Edward W. Hook M.D.
33 months ago
I failed to answer this thread earlier and will address your follow-up question today here.  That you had persistent HPV requiring LEEP in no way changes my assessment or advice.  The subject of oral cancer due to HPV is an evolving area of research but as yet, all data suggest that risk for oral cancer due to HPV remains relatively low and there are no data to suggest alternative screening procedures.  My sincere advice is for you to do your best not to worry about this other than taking the steps we've already outlined.  Please try not to let concerns about oral cancer due to past oral sex dominate your thoughts. your risk is quite low.  

With this reply, I will now close the thread.  IT is unlikely that we will have further advice or suggestions beyond what we've already shared. EWH
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