She must have acquired the infection at least 10 years ago as we’ve both been faithful throughout our marriage.

After spending a few weeks worrying about her and researching high risk hpv I decided to come here and ask some final questions.

1. can persistent hpv clear itself or go dormant even after such a long time? (10+ years)

2. Her previous smears have always been clear, (although this was her first hpv test)  would this indicate that the virus has been dormant and has now been activated by something such as stress?

3. I’ve performed oral sex on her at least once a week throughout our marriage, would it be wise to stop now to give my body a chance to clear oral hpv if I have it?and to stop reinfecting her if I don’t clear it? Would condoms be a good idea?

I’ve read that a man’s immune system isn’t as good at creating antibodies to stop reinfection.

4. My wife drinks quite moderately (strictly weekends) having only 3 glasses of wine or beer a weekend. Would it be beneficial for her to stop in order to give her body a better chance at fighting hpv. 

Many thanks for any advice.

You're in a very common situation, and one we deal with fairly frequently:  routine Pap smear, often with positive HPV test, in women in long term committed relationships. As in your case, the large majority of these situations represent reactivation of a long dormant HPV infection, often acquired years or even decades previously. There is nothing abnormal about cervical HPV infections behaving this way. Of course HPV is sexually acquired, and some such infections undoubtedly reflect newly acquired infection, but usually not. If you continue to be confident in your wife's sexual fidelity, this event doesn't question it. For the decades before HPV was known as the cause of cervical dysplasia and it wasn't known to be sexually acquired, nobody advised any change in behavior of their male partners, and this policy resulted in little or no future harm to either partner. That remains the case, even with modern understanding of sexually acquired HPV. 

1,2. Therefore, you maly have predicted the responses to these questions:  Indeed HPV can go dormant and then reactive months, years, or decades later. This explains most abnormal paps and Pap-associated HPV infections in married/monogamous women. Normal Pap smears in the intervening years is the usual situation.

3. Although your wife had detected DNA only this time, probably there have been period when testing would have been positive if it had been done. You can safely assume you have been repeatedly exposed to your wife's HPV, both genitally and orally. Stopping either intercourse or oral sex now would be like closing the barn door long after the horse is out galloping over open fields. Probably you have been infected and are now immune to that particular strain of HPV, and hence will not acquire it again regardless of future exposures. The same is true of your wife:  if you have an active HPV infection, your wife will not catch it again from you. Stated more simply, couples do not "ping pong" HPV back and forth. Accordingly, there is absolutely no health benefit to you or your wife in changing your sexual practices at this time. 

4. Modest alcohol intake has no known effect on HPV reactivation, the course of cervical dysplasia (e.g. the frequency that it progresses to cancer), etc. No change in alcohol consumption is necessary. (The only factor well documented to have such effects is cigaret smoking, which increases the frequency and speed at which cervical dysplasia processes toward cancer.)

The main necessity now is for your wife to follow her doctor's advice about whatever she recommends for follow-up paps, examinations, or perhaps colposcopy (to assess dysplasia progression toward cancer. You also should remain alert to any penile skin abnormalities, in particular wart-like growths or open sores that do not heal promptly. But almost certainly these won't happen.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

Probably your wife will clear the HPV infection and future Pap smears probably will return to negative.

I'm not a gynecologist or colposcopist; STD specialists usually do not provide this kind of care in the US (although in the UK some may do so as GUM specialists). However, I can assure you that cervical cancer is rare in women in your wife's situation who have colposcopy and any recommended follow-up exams or procedures. That's why Pap smears are so effective in preventing cancer:  treating pre-cancerous lesions is nearly 100% effective. This isn't worth any significant worry; you shouldn't lose even one night of sleep over it. I'm sure her gyn will confirm this perspective. Progression to cancer is "quite common" only in untreated women who ignore their abnormal Pap smears; and even then, the large majority do not progress to cancer. When that happens, the early stage (carcinoma in situ) progresses to invasive cancer -- i.e. becomes dangerous -- after an average of 5 years.

I recommend against you being tested for HPV. It is uncertain what anatomic site(s) need to be sampled, and no single sample site can detect all infections. A urine or urethral swab probably detects under half of all HPV infections present compared with multiple site sampling, e.g. glans, shaft, under foreskin, urethra and urine. Second, the results don't matter: whether or not HPV is present, including high risk (cancer causing) HPY types, makes ZERO difference in risk of future cancer or its prognosis if penile cancer develops. Don't waste your money! As I said in my opening comments, none of this would have been a consideration for the first 50+ years after Pap smears came into routine use, and in those days the frequency of important health outcomes in affected women's sex partners was no higher than it is today.