HPV and Cancer

[worried1188]

Dear Dr,

I was diagnosed with early stage breast cancer in mid 2008 and have completed chemotherapy in early 2009. I have just been told by my doctor that i have genital warts (filliform type) caused by mild HPV. I have been in an exclusive relationship with my partner for 3.5 years and the last time we had sex was 2.5 years ago.

I was initially very alarmed by my diagnosis of HPV although my doctor was not particularly concerned as it is not malignant. There was little information offered which makes me even more worried.

1. I am scheduled for a pap smear in 2 weeks time and also insisted on HPV test. After looking through the information on the net, i came to the conclusion that the genital warts are most probably caused by low risk type HPV. Given my cancer history, i would think that it is prudent to go for the pap smear and also HPV tests. What do you think? How often should i have these tests? 6 months?

2. As i have been celibrate for the past 2.5 years, i would think that my compromised immune system due to chemotherapy is most likely the reason the HPV infection was triggered although it may have lie dormant before.

3. I have most relieved to read about your comments abt telling my partner. As i have the same partner for the past 3.5 years, in my opinion telling him is not an obligation at this point in time as i may have been infected by him unknowingly as this is a rather common STD or he may already have been infected through our previous sexual encounters? Please advise

4. I have been treated via cauterisation and now recovering. My doctor has told me not to have sex in the next 3 weeks for recovery purposes.I intend to use condoms to prevent pregnancy since i have just finished cancer treatment. What about the implications should i have unprotected sex with my partner?

5. I have been told that the body immune system will suppress the HPV virus and it should be suppressed within on the average 9 months?

[Edward W Hook, MD]

Yes cautery is therapy.  Nearly all widely used therapies for warts  ( freezing, application of acid or application of podophyllin)  are based on the idea that destruction of the wart will both make it go away, allowing regrowth of normal tissue and the idea that the damages wart will act to stimulate immunity to resist both the current infection and future infection.  

EWH

[worried1188]

Thanks for your prompt reply.

One more question before i close off this thread:I had cauterisation of the warts. Are they considered therapy? What other therapy is there for me? i know that the HPV infection can even go away on its own in time.

[Edward W Hook, MD]

Welcome to our Forum.  Before I address your specific questions, let me assure you that your breast cancer and the risk for cancer related to HPV infections are not know to be related. These are independent processes.  In addition, it is my impression that you have researched the topic and thus are aware that, for better or worse, at present HPV is a "fact of life" and most people have it or will have it at some point in the future.  Despite this fact, only a tiny minority of persons with HPV get the major consequences of infection (primarily women and primarily cancer and pre-cancerous lesions).  HPV is the most commonly acquired STD.  Over 85% of sexually active women will have HPV infection at some time in their lives.  The figure for men is less well studied but similar.   In some HPV will cause genital warts, in others it will not cause warts but may lead to changes in PAP smears.  In nearly everyone who gets HPV, warts or otherwise, the infections will resolve by themselves without therapy in 8-24 months.  In a very small minority of women, HPV infection can persist and lead to the pre-cancerous lesions that PAP smears detect and which can then be treated.  In your case, as given your history, it is reasonable to assume that the therapy you have received for your breast cancer may have allowed HPV infection which was latent for years to make itself apparent.  Many HPV biologists believe HPV DNA usually or always persists indefinitely.  However, even with the most sensitive tests available in research labs, the virus becomes undetectable, typically over several months to a year or two -- longer for the high-risk (cancer-associated) HPV types, shorter for low risk and wart-causing strains like HPV-6 and -11.  After that, it is uncommon for that particular infection to reactivate -- i.e. recurrent warts or newly abnormal pap smears are infrequent -- and subsequent transmission to sex partners is rare.  When it does occur it does so in situations similar to yours.  With these comments as background, let's address your specific questions:

1.  Getting a PAP smear is appropriate.  We do not recommend HPV testing however.  You already know you have HPV (warts) and what you should focus on is whether you have a pre-cancerous PAP smear change which warrants therapy, not whether or not you have HPV.  If you have an abnormal PAP smear your doctor will talk with you about how to manage that based on the test results.  On the other hand, if you have HPV without PAP smear changes there is nothing to be done but watch and see if something happens.  If your PAP smear is negative and you have another negative at 6 months after that, I would then go to annual PAP smears.

2.  I agree.  I suspect the reason your HPV has manifest itself at this late date is related to your chemotherapy.

3 and 4.  I see no reason to have to discuss this with your partner unless you want to, whether or not you have unprotected sex.

5.  With therapy, clearance of virus is, if anything, faster.  Once your treatment for warts is complete it they do not return in 6 months you should consider yourself cured

You are doing the right things.  Glad to hear you got the HPV vaccine, that was a good thing to do as well. I see no need for additional concerns or precautions beyond those you have described.  Take care.  EWH.  

[worried1188]

The results of the biopsy is as follows:"Section shows fragments of papillomatous lesion characterised by acanthosis and papillomatosis with the supporting papillae showing vascular congestion and mild lymphocytic inflitration. The epithelium shows mild koilocytic changes. No dysplasia or malignancy seen. Diagnosis - Vulval lesion consistent with viral wart with associated mild HPV changes"

Please advise if there's anything else to it that i am not told already. Now that i have undergoing cauterisation, how infectious am i at this current moment should i have sexual intercourse with my long term partner after 1.5 months from now?

[worried1188]

I forgot to add that i have also just been vaccinated for HPV 16 & 18 using Cervatrix