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HPV high risk SIL
Dear Doctor,
Here is a little history on me first. In 2005 I had my first abnormal pap smear. It tested positive for high-risk HPV. I had a colposcopy done and the doctor said that the changes were minor and that they would retest in 4 months. My next pap was normal.
Five years later in August of 2010, my pap came back abnormal again and it was low grade SIL. They did a colposcopy and performed one biopsy. The biopsy came back "good" so no further procedures were done. In January of 2011, I had another pap done and it came back abnormal again, but it was the atypical cells of undetermined significance category. In May of 2011, I had my third pap and it came back normal. I was so happy! But then, my fourth pap test this September of 2011 came back abnormal and was high grade SIL.
I cannot even tell you how upset I am over this news. I did everything right. I got my paps taken every four months and it looked like everything was getting better (went from low grade to atypical cells to normal.) I don't understand how in four months my pap could get so bad. I am suppose to get a colposcopy done next week, so hopefully I will know more then.
Could you please explain why my pap test went from normal to high grade so quickly, and can you tell me if you think I will get cancer? (I heard that there is a small percentage of women with high grade SIL who actually HAVE cancer.)
If I was infected while I delivered her (vaginal delivery,) could I have passed this awful virus to her? That is what I am most concerned with....I want to make sure I didn't infect my own daughter via the vaginal delivery.
Thank you very much for answering my questions.
Here is a little history on me first. In 2005 I had my first abnormal pap smear. It tested positive for high-risk HPV. I had a colposcopy done and the doctor said that the changes were minor and that they would retest in 4 months. My next pap was normal.
Five years later in August of 2010, my pap came back abnormal again and it was low grade SIL. They did a colposcopy and performed one biopsy. The biopsy came back "good" so no further procedures were done. In January of 2011, I had another pap done and it came back abnormal again, but it was the atypical cells of undetermined significance category. In May of 2011, I had my third pap and it came back normal. I was so happy! But then, my fourth pap test this September of 2011 came back abnormal and was high grade SIL.
I cannot even tell you how upset I am over this news. I did everything right. I got my paps taken every four months and it looked like everything was getting better (went from low grade to atypical cells to normal.) I don't understand how in four months my pap could get so bad. I am suppose to get a colposcopy done next week, so hopefully I will know more then.
Could you please explain why my pap test went from normal to high grade so quickly, and can you tell me if you think I will get cancer? (I heard that there is a small percentage of women with high grade SIL who actually HAVE cancer.)
If I was infected while I delivered her (vaginal delivery,) could I have passed this awful virus to her? That is what I am most concerned with....I want to make sure I didn't infect my own daughter via the vaginal delivery.
Thank you very much for answering my questions.
MEDICAL PROFESSIONAL
That's true; perhaps many more babies are infected than we know. But if we never know, i.e. it never causes symptoms or disease, what does it matter? Could this explain the infrequent cases of genital HPV infections detected in virgins? Probably not, but there's probably no way to know for certain. But for sure this isn't a significant health risk and no need to worry about it.
All humans are immersed in and infected by innumerable viruses and bacteria. There probably are many more we don't know about than those we do. HPV is simply one of them -- slightly unique in that some strains are primarily genital and usually transmitted sexually, but otherwise not at all special. We are smothered in such organisms. Happily, the large majority cause no health problems, and even when they do, the same strains may more commonly be beneficial in ways we don't understand.
All humans are immersed in and infected by innumerable viruses and bacteria. There probably are many more we don't know about than those we do. HPV is simply one of them -- slightly unique in that some strains are primarily genital and usually transmitted sexually, but otherwise not at all special. We are smothered in such organisms. Happily, the large majority cause no health problems, and even when they do, the same strains may more commonly be beneficial in ways we don't understand.
Thank you for posting back. I guess my only other question would be how would one know if a baby was infected with high grade HPV since there really aren't any symptoms? It just seems like it could easily be passed to a newborn and no one would even know it. Thank you for your reply.
MEDICAL PROFESSIONAL
Welcome back to the forum. These are excellent questions, and I'm using this as an opportunity for a blog-like response that may help other users in the future. However, you should understand that STD experts do not manage women with SIL or other pap smear abnormalities; you're more likely to get more expert help from a gynecologist. But here are some thoughts you may find useful.
HPV infections can persist; and people with past HPV can catch new infections. Either recurrent or new infection can result in squamous intraepithelial lesions (SIL), either low (LSIL) or high grade (HSIL). That your current result is HSIL doesn't necessarily mean rapid progression. Pap abnormalities do not necessarily go through a sequence from atypical to LSIL to HSIL; the very first abnormality can be HSIL. Further, the natural course of HPV is not affected by lifestyle, diet, etc, etc -- in other words, outcomes like yours are equally common regardless of "doing everything right". (I'm not eve sure what you mean by that phrase -- but it doesn't really matter. This is not something you have any control over.)
As to whether quick progression of a pap smear from normal to HSIL predicts a higher risk of progression to cancer, I cannot say; this is one of those issues that your gynecologist will know more about. But if there is any effect along these lines, it is minor. The average time from such abnormalities to actual invasive cancer is 10-20 years; and even then, most cases are readily curable.
Further, the more accurate kind of test -- a biopsy of your cervix -- will give more reliable information than the pap. Some cases of HSIL turn out to actually be low-grade by biopsy. But even high grade lesions are very effectively treated by removal of the infected tissues, e.g. by the procedure called LEEP (loop electrosurgical excision procedure).
As for transmission to your latest child, the chance that happened is low. Look at it this way: in the US, millions of women have cervical HPV at any point in time; and with ~4 million live births per year, obviously hundreds of thousands of babies are born each year to women with active cervical HPV infections. Yet the frequency of genital type HPV infections in young children is exceedingly low. And when that occurs, it's primarily with the low risk (wart causing) HPV types, not high risk (cancer causing) strains.
So the most important thing by far is for you to keep your appointment for colposcopy and, most likely, cervical biopsy. The chance that this will turn out to be serious is very, very low. Discuss all these issues with the gynecologist. You could even consider printing out this thread as a framework. You can expect him or her to agree with my opinions and advice (although if they conflict, you should rely primarily on his or her advice over mine).
Bottom line: I understand how disconcerting and even alarming this situation may be, but it really shouldn't be. When all is said and done, this will fade into a period of health-related inconvenience, not a serious health threat to you, your children, your husband, or anyone else.
I hope this has helped. Best wishes-- HHH, MD
HPV infections can persist; and people with past HPV can catch new infections. Either recurrent or new infection can result in squamous intraepithelial lesions (SIL), either low (LSIL) or high grade (HSIL). That your current result is HSIL doesn't necessarily mean rapid progression. Pap abnormalities do not necessarily go through a sequence from atypical to LSIL to HSIL; the very first abnormality can be HSIL. Further, the natural course of HPV is not affected by lifestyle, diet, etc, etc -- in other words, outcomes like yours are equally common regardless of "doing everything right". (I'm not eve sure what you mean by that phrase -- but it doesn't really matter. This is not something you have any control over.)
As to whether quick progression of a pap smear from normal to HSIL predicts a higher risk of progression to cancer, I cannot say; this is one of those issues that your gynecologist will know more about. But if there is any effect along these lines, it is minor. The average time from such abnormalities to actual invasive cancer is 10-20 years; and even then, most cases are readily curable.
Further, the more accurate kind of test -- a biopsy of your cervix -- will give more reliable information than the pap. Some cases of HSIL turn out to actually be low-grade by biopsy. But even high grade lesions are very effectively treated by removal of the infected tissues, e.g. by the procedure called LEEP (loop electrosurgical excision procedure).
As for transmission to your latest child, the chance that happened is low. Look at it this way: in the US, millions of women have cervical HPV at any point in time; and with ~4 million live births per year, obviously hundreds of thousands of babies are born each year to women with active cervical HPV infections. Yet the frequency of genital type HPV infections in young children is exceedingly low. And when that occurs, it's primarily with the low risk (wart causing) HPV types, not high risk (cancer causing) strains.
So the most important thing by far is for you to keep your appointment for colposcopy and, most likely, cervical biopsy. The chance that this will turn out to be serious is very, very low. Discuss all these issues with the gynecologist. You could even consider printing out this thread as a framework. You can expect him or her to agree with my opinions and advice (although if they conflict, you should rely primarily on his or her advice over mine).
Bottom line: I understand how disconcerting and even alarming this situation may be, but it really shouldn't be. When all is said and done, this will fade into a period of health-related inconvenience, not a serious health threat to you, your children, your husband, or anyone else.
I hope this has helped. Best wishes-- HHH, MD
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