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How is HPV contracted?

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Posted on Wed, 28 Oct 2015
Question: I am in my early forties and have been with my husband faithfully for 12 years. I have a 2 year old with him and a 4 year old. All my paps in the past were all normal. I had a recent pap two weeks ago that came back as ASCUS with positive High Risk HPV. I have had a pap 2 years and 3 months ago that was normal. I called that OBGYN and was told they only run the HPV test if the pap comes back abnormal and since mine was normal they did not run it. I have had a pap 2 years prior to that one with no abnormal cells too. But not sure if HPV was ran but according to the Naval Hospital's web site I had it at they do HPV testing with paps on women over 30 (that's me). I had my a Colposcopy yesterday and asked my OBGYN to be honest and how likely is it that this virus has been dormant in my body. She was tactful and truthful, she said, "if you had been tested for HPV in the past few years and have had normal pap smears it is extremely unlikely your HPV has been laying dormant in your system for 12 years that at some point even if the pap smear was normal there would be enough HPV in the cells to pick up a positive HPV screening". Then I asked how accurate the test were and she told me it is only a 1% chance to have a false positive test. When she looked with the light on my cervix she saw some abnormal cells between 12 & 1 O'clock and at 3 O'clock but she did not see any dysplasia. I asked the OB in her opinion when did she think I contracted this virus, her answer "I can say with a high certainty it was about year or so ago." I had told her my husband and I have been having marital problems these past couple years. So, I wanted to know if it was possible that my husband in fact cheated. The OB did say if it was chlamydia she could say with a 100%. My husband, about a year and a half ago, went out drinking with his friend and didn't come home one night and we fought one other night so he went to a hotel. I had asked his friend's wife the next morning if he was at their house and she said "yes". So, now I really think this wasn't dormant. He is completely denying any cheating ever, but I believe an OBGYN(s) opinion over my husband just saying he didn't cheat. He has now asked me to get a second opinion. So now I am soliciting an OBGYN online. :) My OBGYN never said forsure but she used words like, "with high certainty" when saying when she blieves I contracted the HPV and "extremely unlikely" when explaining it's been dormant. As an OBGYN do you feel the same way she does about this new DX of high risk HPV I now have. She also said it should go away in a year and my lab results will be back in a week or so. Thank you.
doctor
Answered by Dr. Timothy Raichle (32 minutes later)
Brief Answer:
Timing of HPV exposure is uncertain...

Detailed Answer:
I completely understand your concerns. We regularly have patients with no history of abnormal pap smears, in whom we check HPV in order to spread out the timing of pap smears, and in whom HPV comes back positive. These are among patients in whom there is no concern about infidelity.

And abnormal pap smears come up after years of normal pap smears with non certainly regarding when the actual exposure happened.

Here is what I tell patients: "you have these results because you are a human being who has ever been sexually active." You may have always been positive for high-risk types and never had abnormal pap smears. On top of this, "atypical cells" on a pap smear (ASCUS) can be for reasons unrelated to dysplasia or precancerous changes (e.g. a yeast infection or inflammation). Hopefully your OB did testing for chlamydia and gonorrhea as well.

So, for your OB to be so certain is just feeding into a concern that was already there before the pap smear was done. I do not personally believe that they can make a conclusion with such certainty. What we know about cervical cancer is that it takes years to decades to go from dysplasia to cancer. It IS possible that you have always been positive for high-risk types, but it was just never tested. And yes, this can be the case in the setting of normal pap smears.

So, I am not saying that you do not have any concerns about your marriage, but I do not think that this is the "smoking gun" by any stretch. I would recommend that you consider marital counseling (you could even go alone at first).

I hope that this helps.

Dr. Tim
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
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Follow up: Dr. Timothy Raichle (2 hours later)
Thank you for your answer. My OB said extremely unlikely this was dormant because she said it is normal practice for an HPV test during a Pap smear for women over 30. I had my 4 year old at a Naval Hospital and had a pap prior to him (when I was 37/38) and after him. They were normal and they test for HPV. My last pap I was told if it was normal they don't run they HPV test (I don't know if I understand the nurse right because her accent was strong) but she said the results were normal. So not having a history of testing positive for HPV it seems from your answer and her response it would be extremely low chance I was carrying the virus in the past and I was recently exposed to it? Is that a fair statement?
Also, I did have a yeast infection in my pap results from 2 weeks ago...and I wasn't tested for gonorrhea or chlamydia.
The only reason I had my pap done before 3 years as my last Obgyn suggested was because I ended up admitted to a hospital a couple months ago with a hemoglobin of 5.4 and hematocrit of 18 and received a blood transfusion and told to get a hysterectomy. I am doing hydro ablation but did discussed with my OB yesterday about doing a hysterectomy because of this diagnosis and a fibroid. She said HPV can still cause vaginal cancer and anal cancer and other cancers and she thought ablation is fine. Otherwise I'd be waiting another year and not knowing if I wasn't so anemic. I do agree with martial counseling. So... is it correct to say not testing positive for HPV before and testing positive now is the "smoking gun" or are you saying I could still have tested negative 4 years ago after my son and still had normal paps until now (because I don't think my OB tested me for it after I had my 2 year old because my pap was normal) not trying to be confusing just want to be fairly certain either way. Thank you again!
doctor
Answered by Dr. Timothy Raichle (17 minutes later)
Brief Answer:
Not sure if they ran HPV before..

Detailed Answer:
The recommendations for using HPV to triage pap smears was not at all routine 4 years ago. So, the triage RN on the phone who could barely speak English is not really a good source of information. My guess is that they did NOT run HPV on that pap smear. The best way to sort this out is to request an actual copy of the result, and any results since that time. Often it will say on the pap smear result if HPV was run.

And yes, if you had prior HPV testing that was negative, and now it is positive, then I would agree that there has been a new exposure in between that time period. But as I said before, you can be positive for HPV and have normal pap smears. So, it becomes important to sort out whether or not this was ever run on a pap smear. Given the signficant conclusions you are reaching, don't you think that it would be important to absolutely get these facts straight?

Also, given your OB's relative insistence that your husband must have cheated AND the fact that she even brought up the issue of Chlamydia, then why did she not run this test? It can be run right off of the pap smear vial. I would schedule a visit for full STD screening to resolve this issue as well.

So, if the punchline is that you never had HPV tested before AND all of the STD's are negative (which sounds like the most likely scenario) then you are left with uncertainty about when exposure occurred (which could have been 10+ years ago). If you had prior HPV testing done that was negative (which you will confirm by getting a copy of those records) and NOW it is positive, then I would agree with your OB that it is suspicious that this exposure is new and someone has some explaining to do.

With regard to your bleeding problem, if you bled so much that you needed a transfusion AND you have uterine fibroids, you need:
1. A workup to make sure that you do not have a bleeding disorder
2. A second opinion regarding ablation vs. hysterectomy

I hope that this helps
Dr. Tim
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Timothy Raichle (1 hour later)
It does thank you.
I called the OB nurse at the naval hospital and she said they only did a pelvic and chlamydia screening which was negative. No pap or HPV screening there. And before that I probably was never tested for HPV because my paps were normal and probably not standard practice back then.
So no way to tell. I will trust him.
Why would my OB say after looking at the cells she saw the cells after the spray and light (she even turned the light more green or something like that to see any dysplasia better or something) why did she say it looked like I would of had it a year or so. Does that just mean that's when she suspected the cells changed. All so confusing to me. She said she suspected that's when I got it. Her high certainty of exposure.
Also, I do now see a hematologist and that dr also wants a endoscopy and colonoscopy but not done till my iron levels are up. But my vitamin B was down to 300 so I get vitamin B injections now.
The OB did say 95% chance the ablation will work and if the fibroid grows or it doesn't work for me we will revisit the hysterectomy.
Do you believe my HPV will clear up and if I have had it for 10+ years does that mean my immune system has been unable to fight it and I could end up with cancer?
Last question I promise and thank you so very much!!!!
doctor
Answered by Dr. Timothy Raichle (1 hour later)
Brief Answer:
Consider a hysterectomy, see below...

Detailed Answer:
You cannot look at a cervix (colposcopy) and tell how long a problem has been present. This is really not possible. I guess you will know if they are right after you get the biopsies back (she did biopsies, right?). If the biopsies are negative for dysplasia, then I guess it puts into question your OB's 'certainty' about everything.

As far as the GI workup, I guess it makes sense to rule out other problems or sources of bleeding besides your uterus. But my guess here is that it is all going to come back to the uterus as the source of the problem.

Finally, to quote you a 95% chance that the ablation will "work" is ridiculous. How do they define "work"? If it is saying that you will have a 95% chance of never bleeding again, then they are lying and you need a second opinion. Maybe they could quote a 50/50 chance of minimal to no bleeding again, at best.

Consider the following:
1. You have a uterus that likes to bleed
2. There are fibroids present
3. Fibroids are often a cause of failed ablations
4. Your cervix is now giving you trouble and with an ablation, you are still going in more frequently for pap smears and perhaps even future procedures on the cervix itself
5. A hysterectomy, in your case, removes the fibroids AND the cervix

So, I think that your OB has said a few things that, to me, warrant a second opinion. While a larger surgery is certainly associated with more risk, it is worth strongly considering. And lastly, you definitely need a workup to make sure that you do not having some kind of bleeding disorder (ask the second opinion about a test for Von Willebrand's disease)

Dr. Tim
Above answer was peer-reviewed by : Dr. Yogesh D
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Dr. Timothy Raichle

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Practicing since :1999

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How is HPV contracted?

Brief Answer: Timing of HPV exposure is uncertain... Detailed Answer: I completely understand your concerns. We regularly have patients with no history of abnormal pap smears, in whom we check HPV in order to spread out the timing of pap smears, and in whom HPV comes back positive. These are among patients in whom there is no concern about infidelity. And abnormal pap smears come up after years of normal pap smears with non certainly regarding when the actual exposure happened. Here is what I tell patients: "you have these results because you are a human being who has ever been sexually active." You may have always been positive for high-risk types and never had abnormal pap smears. On top of this, "atypical cells" on a pap smear (ASCUS) can be for reasons unrelated to dysplasia or precancerous changes (e.g. a yeast infection or inflammation). Hopefully your OB did testing for chlamydia and gonorrhea as well. So, for your OB to be so certain is just feeding into a concern that was already there before the pap smear was done. I do not personally believe that they can make a conclusion with such certainty. What we know about cervical cancer is that it takes years to decades to go from dysplasia to cancer. It IS possible that you have always been positive for high-risk types, but it was just never tested. And yes, this can be the case in the setting of normal pap smears. So, I am not saying that you do not have any concerns about your marriage, but I do not think that this is the "smoking gun" by any stretch. I would recommend that you consider marital counseling (you could even go alone at first). I hope that this helps. Dr. Tim