STDs Expert Forum
HPV 16 positive
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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HPV 16 positive

I have always had normal pap smears but since turning 30 and having my first HPV test it came back positive for HPV 16. Why then were my paps always normal?

I had a colposcopy this week and I am very nervous about the results. During the colposcopy the doctor noted that I have a retroverted (or tilted) uterus so she could not see my "transformation zone". Is this possibly why my pap tests have always come back normal despite being HPV positive?

Last, I am most concerned about having an LEEP and that affecting my fertility. I do not have children but definitley want them. Do you have any statistics or any peer reviewed studies I can read about this? I am preparing myself mentally for the work case senario.
239123_tn?1267651214
Welcome back to the STD forum and thanks for your question.

This sequence of events is the usual one for abnormal pap smears and cervical HPV infection.  Most genital HPV infections are acquired before age 25, then disappear.  Most infections don't reactivate, but a few do so.  That's why having HPV, especially with a high risk type like HPV-16, is taken more seriously at age 30 and higher than at younger age.  This doesn't mean you are at especially high risk of cancer, however.  With proper management and follow-up, actual cancer will be prevented.  This is exactly why pap smears are more important in women after age 30.

Your other questions are more appropriate for your gynecologist, which I am not; s/he undoubtedly knows much more than I do about these issues.  My belief is that your retroverted uterus is not related at all to why your pap smears were normal in the past.  As for LEEP, my understanding is that the benefits to you (removing HPV infected tissues and reduced cervical cancer risk) far outweigh the relatively low risk of cervical incompetence that can result in premature delivery or otherl problems in pregnancy.  I predict your doctor will agree -- but he or she is the better expert.  (You could consider printing out this thread as a framework for discussing all your questions with him or her.)

Good luck to you.  Don't lose a lot of sleep over your upcoming LEEP or your future cervical/uterine health.  Your situation is a very common one, and with proper management, bad outcomes of any kind are rare.

Let me know if anything isn't clear--  HHH, MD
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The question I still have is why did the pap show normal if I have HPV? They were taken at the same time.
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239123_tn?1267651214
I didn't understand that the pap itself was normal this time; I assumed your comment about normal paps was about earlier ones only.  But I'm not surprised.  This is exactly why HPV testing is now routinely recommended along with traditional pap wmear:  the HPV test is more sensitive, i.e. picks up more pre-cancerous changes than paps do.  In fact, someday it may be recommended that traditional pap testing be stopped entirely in women age 30 and up, to rely entirely on HPV testing.

I look forward to hearing more after you've either spoken again with your gyn and/or had the LEEP.  
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