HPV unaswered questions/concerns

[poco1023]

Hi Doctor. So glad I'm getting chance to speak with you.  Here is my story.  I'm a 44 yr old female. I've been going regularly to have papsmears since I was 18. I had an abnoral pap smear back in 2001. I was told then I had HPV and needed to get a colposcopy done. I had the procedure done and it came back negative, no cancer, but positive for the hpv virus. Since then I've kept up on my pap smears as normal. On june 19th this year I went for my check up and also had them test me for hpv this time. I had a normal pap smear, but tested positive for high risk hpv. I had the colposcopy done and a biopsy taken, and no cancer. I've been with the same b/f this whole time and he's very aware of all this. my questions are:

1.  In all these years, neither of us has had any visible signs of the virus. Would we have seen something during all these years, warts, etc.

2.  Can I find out what strain/type I have? If so, how do I get this done?

3.  I'm sure at this point my b/f and I have both been infected. Do we keep passing it back and forth or is there a time where we're both clear from infection?

4.  Is it possible I've had the virus all these years and it's never gone away, has never cleared up?

5.  On average when you've been diagnosed with the virus, how long does it take to clear up and is there any way of knowing?

5.  If a pap smear comes back normal, is it really necessary to have the colposcopy done?

I want to say thank you up front for helping me to get my answers.  My doctor wasnt very helpful.  I think he sees this all time and just isnt concerned as the people who are caring it around. When he said the biopsy came back negative for cancer I asked what do I do now, he said "see you next year".  I've read a good majority of the postings and can't believe how many people have this.  Sad to say that so many of us do have this, but on the other hand it's comforting to know I'm not alone.

[H. Hunter Handsfield, M.D.]

I'll go straight to your questions.

1) Your and your partner's lack of symptoms is typical.  The high-risk HPV types (those associated with cancer and most pre-cancer pap smear abnormalities) usually do not cause warts and are entirely asymptomatic.

2) In general, such tests are limited to research settings.  But what's the point? The type makes no difference in your risk for further problems, your treatment, etc.  Treatment is based only on what the pap smear and what the colposcopy and/or biopsy show, not on HPV type.

3) In general, people probably do not "ping pong" HPV infection back and forth.  This isn't know for sure, however.  Indeed your partner may still be infected, but it is more likely he has been infected but no longer carries the virus and is immune to catching it from you again.  There is no way to know, but it probably doesn't matter.

4) Yes, that's probably what happened.  Reactivation of your own latent infection probably is more likely than having caught a new HPV strain.  But it's possible.

5) Among all new infecitons with high risk HPV types, 75-80% clear up within a year and 90% within 2 years.  Repeat HPV tests with pap smears can help figure it out, but not precisely.  Some people undoubtedly remain infected even though HPV DNA can no longer be detected.

6) I am not an expert on management of abnormal pap smears or HPV of the cervix, and I don't provide direct clinical advice online.  I believe the answer is yes, you still need colposcopy.  But follow your own provider's advice.

Your provider's attitude, that pap abnormalities and cervical HPV infections are inconveniences more than serious health threats, is not inappropriate.  (Not that he shouldn't be insensitive in how he conveys it.)  Almost all cervical cancer in the US occurs in women who never get paps at all, then show up with bad disease.  It virtually never happens in women in your situation.  Your risk for a serious health outcome is zero, as long as you get appropriately diagnosed, treated and followed.

Best wishes--- HHH, MD

[poco1023]

Thank you doctor for all your advice and easing my mind a bit.  Currently I seem to have some new symptoms that just arrived yesterday.  I had sex with my b/f on thursday, friday I felt fine. We had sex again on saturday and yesterday my vagina started to feel a bit uncomfortable, irritated. I believe I see 1 or 2 very small white bumps but not in the area where the vagina feels irritated and red. When I open the lips of the vagina this is where its red and irritated, yet there is no burning when I urinate just a minor discomfort.

1. Even though I was diagnosed with high risk hpv would I still get warts?  
2. If I have them now would they cause these types of symptoms after sex?

3.  When I had the pap smear and colposcopy done if there were warts present at that time wouldn't the doctor have seen them?

4. Is there a certain procedure/test he needs to run to see if I have them currently or not?

I'm planning on making a doctor appt today, but I wanted check in with you to see if these symptons are similiar to genital warts.  thank you for you help.

[H. Hunter Handsfield, M.D.]

1) High risk types rarely cause warts.  But many people are infected with more than one HPV type.

2) I cannot comment on the cause of your "white bumps".  HPV doe not cause redness or irritation after sex.  You are right to plan on seeing your doctor about it.

3) Probably your doc would have recognized warts if they were present when you had colposcopy.  But small ones can be missed.

4) There is no test for diagnosis of HPV in men.

Regards--  HHH, MD

[poco1023]

Thank you doctor for getting back to me. Just a few more questions, then I'll be done. I did make an appt with the doctor for friday.  My conditions now are redness, irritation itching and some discomfort when I urinate, but not much. The white bumps i thought I saw earlier were really a discharge that is white and thick, could it just be a yeast infection?  

1.  Do colposcopys have a history of bringing on yeast infections?  Even though I had it done on July 10th?  I did bleed for about 8 days from the procedure then my period immediately followed. Is this possible?

I cant tell you how much comfort this site has brought to me.  You've been terrific in helping me understand this virus. From the first time I found out I had this virus I felt like damaged goods, but thanks to you I no longer feel that way. I can't thank you enough!

[H. Hunter Handsfield, M.D.]

Your symptoms indeed are consistent with yeast vulvovaginitis.  Colposcopy is not generally considered a trigger of yeast infections.  However, anythhing that alters the vaginal environment can sometimes trigger yeast overgrowth, and bleeding can do it.  You should contact the provider who did the colpo for his or her advice.

Thanks for the thanks about the forum.  Best wishes--

HHH, MD

[poco1023]

Thanks Dr. HHH.  I'll be seeing my gyno on Friday for the infection and he is the one that did the colposopy so I'll ask him then.  Thanks again for everything and have a great day!

[kerry d]

I had my colposcopy done on monday and a have a very small amount of bleeding and discharge for like 2 hours that day.  It is now friday and I feel like I am getting a yeast infection also.