High risk HPV...

I am married and have been with my husband for over 5 years andI had a pap 2 years ago and it came back ASCUS. I had a colposcopy and the doctor said she didn't see anything wrong and there was no need to do a biopsy. I came back (to a different doctor) 6 months later and my pap results were LSIL. I had a colposcopy in January 2009 and after a horrific biopsy, the results were chronic and acute cervicitis with normal ECC results. I quit my high stress job and started taking vitamins and supplements and have been buying only organic food. I waited until September 2009 and had another pap and the results were ASCUS again and the HPV test showed positive for high risk. They wanted me to do another colposcopy, but I declined because of the terrible pain I felt when they performed the biopsies and the ECC ( I fainted right after!!).
Since then I have moved and I am seeing my normal doctor next month for a pap. I am soooo scared. I don't want to have to go through this all over again! What are the chances that my next pap will be back to normal?? If it's not, can my doctor give me anything so the colposcopy/biopsy will be a better experience? Please help!

[Hollyv]

First of all, an ASCUS Pap result is usually very benign. It is the lowest level of abnormal and it really means that the pathology dept. may have see some things on the smear that were not perfectly normal, so they call it ASCUS which means Atypical Squamous cells of Undetermined Significance, so that was your first one. As you can read in the definition it means some atypical cells and they are not determined. If they did not see anything on the first colposcopy that was good news. LSIL is the second level of abnormal and some Dr.’s believe that this means HPV but it has been determined by studies that it does not mean HPV in all cases. I think 6 months later is a little early to do a second colposcopy but different physicians have their own viewpoints and that may be the reason to ask them questions. Your September 2009 ASCUS result with your high risk HPV result is the reason they wanted you to have another colposcopy but that is due to the guidelines they use. What that means is this is an indication to have a colposocpy with an ASCUS Pap and High Risk HPV result but I think they should have looked at your entire history. Your results from the first colposcopy were normal. Your results from your second were in essence normal they showed no precancer or cancer. It showed some infection, that is what cervicitis is and the ECC results were normal. From what you wrote there were no signs of dysplasia and that is what they are supposed to be looking for—signs of “precancer” and you were no where close to cancer. I think you were smart to decline the colposcopy in Sept. 2009. I understand your nervousness about your upcoming appointment. Personally, I would see an OB/GYN for my next appointment. I would have a Pap test done and I would not have an HPV test done. I would wait for them to call me with the result of the Pap and then make a decision. At that point you could have an HPV test done or a repeat Pap in 6 months or see a different physician. If you did have an HPV infection at some point it can take up to two years to clear and sometimes a little longer. The HPV test can give both false positives and negatives, keep that in mind. I would only have colposcopy if the results were a higher abnormal on my next pap. Many Dr.’s are doing too many colposcopies and biopsies, it does make them money but they are also afraid to miss anything and be sued. The chances are good your next Pap could be normal. The problem is the new liquid based Paps often show abnormalities that mean nothing; you may want to have that discussion with your Dr. also. You can take Advil if you need to have a colposcopy and it sounds like your bad experience was a little unusual, so I would make sure that if needed you get a good colposcopist. The best advice is to get recommendations from others in your area for a good Dr., one that tends to be on the conservative side, that you can trust and only does procedures when necessary. A study done in 2008 at Harvard indicated that 95% of colposcopies were done unnecessarily. You are doing the right thing by decreasing stress and eating well. And just to set your mind at ease, even if you did have abnormal cells from LSIL which it appears you did not, they are usually reversible but in your case it does not appear as that you had anything. All these tests are very confusing! They are also costly and emotionally draining often for no evidence of disease. Hope this helps.

[margie33]

Thanks for the info. It makes me feel better knowing that my results can most likely be normal again.  It's been rough having abnormal paps for over a year and a half now. The last colposcopy/biopsy that I had was terrible because I felt so much pain during the 2 biopsies and the ECC. The speculum was painful as well ( I am very small, sex even hurts!)  I was swollen with cramps for 2 weeks and I was extremely tired. It has just been very emotionally draining knowing that I have high risk HPV. Hopefully my immune system can suppress it so that I don't have to go through this again.

[Hollyv]

I’m sorry you have had to go through this. I don’t really like the HPV test because it does send a lot of women for colposcopy, that don’t need it. My feeling is it should not be done in women under 30 as according to studies it is can unreliable. For those over thirty there are still are still problems with false positives and negatives and it can also cross react with low risk HPV giving a positive result when it is not. In your case with the LSIL, or the ASCUS and positive HPV test result you would have probably been referred anyway. Pap smears have their limitations but have proved to be a successful screening over the years and it is certainly possible that it was ASCUS and then it was “over read” and called LSIL. The newer liquid Paps may indicate irregularities that often don’t mean anything, that is why the American Cancer Society only recommends liquid testing every 2 years. Labs can be a problem but this is often “out of your control” where it goes. I still prefer the old conventional slide smear tests because a pathologist will read it and not a cytotech or computer but I don’t know if your physician will do one as most have switched to liquid based, but you could ask. And, since you had so much pain with colposcopy you could ask your physician if they could do a PCR test, instead of a HPV Test if your Pap comes back as ASCUS. It is harder to find a place to do as it as is often done in academic settings but some labs do it, and it is accurate and will tell you specifically what HPV you have—If you have it! This is the same type of test that identifies DNA for crimes, 99.9% accurate for some HPV PCR tests. This gives you some options for the worst scenario. However as I said before, I would not worry as all your results so far have indicated nothing. And remember cervical cancer is really rare. Most HPV clears and is not anything to worry about and you don’t even know if you had HPV as the Pap had mild abnormalities and the HPV test can be inaccurate and there was no evidence of dysplasia on your colposcopy. Try to relax and I’m sorry your physicians didn’t give you better information but it sounds like your 1st physician was a better colposcopist and did not want to do biopsy’s or an ECC when you did not need it. Post after your appointment, when you get your results—I’m hoping your Pap will be normal. I’m not even sure you had a problem with your immune system, maybe just bad testing.
Good Luck….

[margie33]

thanks.  I will definitely post after I get my results. I am turning 30 this year and I would love to not have to worry about this anymore. I spoke to my doctor and she said if I have another ascus pap, she won't refer me to have another colposcopy, since I'm so traumatized.  I just now really hope it didn't go back to lsil or worse! I also got a yeast infection last month, but I still have some minor itching and I hope it doesn't affect the pap next week.....

[margie33]

So I had my pap last friday and I just got the results and everything was negative!!!! I am soooo beyond happy! It was a rough 2 years of dealing with it.
I owe it all to quitting my stressful job, eating organic, buying nontoxic household supplies, and taking vitamins (multi-vitamin, beta carotene, folic acid, turmeric).
Hopefully I can keep this up!

[Hollyv]

Margie33

I am happy with the good news that your Pap was normal. For others out there they need to understand that Paps are a great screening tool but they do have their limitations. Most are now read by computers and cytotechs and not pathologists. A common sense approach needs to be taken with a repeat Pap before an HPV test and the HPV test should really not be done in women under 30 because a lot will test positive but rarely will there be any of precancer or evidence of disease and even more rare any signs of cancer. It really sounds like you may have been overtreated and that you may have not needed the colposcopy.
I felt confident that your Pap would be normal. If you switch Dr’s in the future you need to bring all your results and explain that even though you had 2 colposopies they found nothing! If you ever need to have an HPV test, I would only have an HPV DNA test that is 99.9% accurate and tests for a specific genotype (specific strain) not the HPV test that indicates you might have any 1 of 13 or the one of two—16, 18 test. When you have 3 normal Paps in a row, you can decrease your screening to every 2-3 years.
Glad everything worked out for you…Good Luck in the future!