I was vaccinated with Gardasil approximately 3 years ago (2007). In order to get the vaccination (since I am over 26yr) I had to pay out-of-pocket and in addition my doctor made sure I had a negative HPV-test prior to administering the vaccine. Unfortunately, about a year after I completed my vaccination (2008) I had a repeat HPV-test along with Pap and tested positive for HPV but had a normal Pap result. I waited a year (2009) and had a repeat HPV and Pap test done and my Pap was normal, HPV-negative. Now, in 2010 I had an abnormal Pap test and tested HPV-positive. I have had one new partner (2010) and believe he has re-infected me with a different strain of HPV since I was celibate since before 2008. I made him get tested for all STDs prior to even starting the relationship and was adamant about using condoms but we did have one unfortunate instance where the condom broke.
After my recent abnormal PAP and HPV-positive test I had to have a Colposcopy test done with result of Koilocytotic Atypia, not precancerous. My doctor stated that this was “the best result I could have gotten given the circumstances” and did not seem worried about this. I am supposed to go for a repeat Pap and Colposcopy in 4 to 6 months and I am very worried.
The questions I have are:
1. Once your body fights off the HPV strain, can you get re-infected with the same strain? Or can the virus remain dormant and then reappear during stressful times?
2. Since I completed the Gardasil (HPV strains 16, 18) vaccine a year prior to my first HPV diagnosis, which other strains are possible that would cause the result of Koilocytotic Atypia, not precancerous?
3. Is there any information regarding the incidence of becoming cancerous for the other cervical cancer causing strains? (Type 16, 18 vs. 31, 45)
4. With a diagnosis of Koilocytic Atypia, what should I expect next and should I be worried?
5. Any suggestions on how I can help my body to fight off this infection (herbals, foods, vitamins)?
I’m not sure how well you understand Pap testing and the HPV test. The Pap is often not really reliable and the reason that it has been so successful for years is repeat testing will find cancers. The average age of cervical cancer is 49. Low grade abnormalities are the hardest for a cytotechnologist to diagnose. In the past number of years the new liquid based tests are picking up small abnormalities which mean nothing and are often processed by a computer. This is the reason that the American Cancer Society recommended Pap testing every 2 years with liquid based Paps not because of accuracy but rather the opposite, inaccuracy. I’m not sure what you mean by Koilocytotic Atypia, not precancerous—Did you mean that is was precancerous. Koilocytotic Atypia is usually a term found on your Pap smear, did you get this result from a biopsy? If you were told it is not precancerous then no need for any test for a year. The HPV test can also be inaccurate and it has both false positives and negatives. Research from Harvard indicates that 95% of women are having colposcopies unnecessarily.
Lets look at your results
2008 normal Pap, HPV positive—This is off label testing unless you are over 30.
2009 normal Pap, HPV negative—Again no need to do an HPV test
2010 abnormal Pap, HPV positive—HPV test should only be done with an ASCUS result unless you request it and you are over 30.
I am really not in favor of HPV tests because all they do is make you worry. What you need to remember is cervical cancer is very rare. Also, these tests are not really accurate and they are screening tests. It is very possible in 2008, you had a false positive HPV test with a normal Pap and then you tested normal in 2009. In 2009, you were normal so that is your start point. In 2010 you have very mild abnormalities, you did not say what they said your Pap test was but I’m guessing ASCUS or LSIL and remember cervical cancer is rare. Some physicians believe Koilocytotic means HPV but that has not been totally proven. There are physicians that don’t totally understand HPV. Also, you did not give your age but if you are over 35, you can have LSIL changes and that is normal due to physiological aging changes. It is also true that two pathologists can read a biopsy and have a different opinion and colposcopy used to be the gold standard but recent studies have indicated that this is not true.
To answer your questions.
1. Yes, you can get reinfected with the same strain. There is a lot of talk about the virus being dormant but for most women when they clear the virus, they clear it forever.
2. The term Koilocytotic Atypia is usually used in the US on Pap Smears. Usually for biopsies the terms normal, CIN 1,2 or 3 are used as they are different degrees of dysplasia.
3. I really would not worry about which strain it is because even if you have HPV it should clear on its own with your immune system within a year. The most common types of HPV in the US in a 2007 journal were 62, 84, 53, 89, and 61. HPV 16 was only found in 1.5% of females and HPV 18 in 0.8% in women 14-59 years.
4. I would not be worried. It could be an HPV infection but it also could be just an infection. Were you told you had any dysplasia with the biopsy? If you are really worried there are PCR tests that can be done to give you accurate information on what type of HPV you have and if you have HPV.
5. You need to just be healthy and eat well and exercise and keep your immune system healthy with lots of fruits and vegetables. If you smoke, you need to quit.
I would try to relax, I know it is hard. I would not be in a rush to have a repeat Pap and I would really discuss the results with your physician. I would have a repeat Pap in 6
months to a year and an HPV test but only if you want one. If you have not had children, I would be wary of the colposcopy if they are going to continue to do biopsies. I would not want one until a year and only if the Pap showed higher grade changes. If you are really worried, I would have the repeat Pap done by a new physician maybe an OB/GYN and have the results sent to a different lab.
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