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Agressive HPV
Hello Dr.,
I am a 30 year-old female (non-smoker) and was recently treated for high-risk precancerous cells on my cervix. No HPV test was done by my OB/GYN, but I am assuming that I have a high-risk type of the virus. Until recently, all of my paps have been normal. However, this year, I jumped to having high-risk cells. Is it normal to have such a dramatic change within a year's time? My fear is that my body does not seem to fight off the virus as well as the bodies of other women. Does this indicate that I am more prone to develop other types of HPV related cancers, such as throat cancer? I understand that the number of HPV related oral cancers is relatively small--approximately 6,000 cases in the US per year; however, am I likely to be in that 6,000 given that it is also fairly uncommon for women to develop severe cervical dysplasia?
I am a 30 year-old female (non-smoker) and was recently treated for high-risk precancerous cells on my cervix. No HPV test was done by my OB/GYN, but I am assuming that I have a high-risk type of the virus. Until recently, all of my paps have been normal. However, this year, I jumped to having high-risk cells. Is it normal to have such a dramatic change within a year's time? My fear is that my body does not seem to fight off the virus as well as the bodies of other women. Does this indicate that I am more prone to develop other types of HPV related cancers, such as throat cancer? I understand that the number of HPV related oral cancers is relatively small--approximately 6,000 cases in the US per year; however, am I likely to be in that 6,000 given that it is also fairly uncommon for women to develop severe cervical dysplasia?
MEDICAL PROFESSIONAL
Welcome to the forum. I'll try to help.
First, as for your pap smear: I agree you probably have a high-risk type of HPV infection, based on having "high risk cells" Most likely that means your pap smear shows high-grade displasia or that a biopsy showed a "high grade squamous intraepithelial lesion", or HSIL. Although low-risk types cause many abnormal pap smears, they generally are limited to lower grade dysplasia or low grade SIL (LSIL).
However, neither that finding nor the apparent speed of progression is alarming at all. Although patients (and some doctors) often assume that paps progress from minor to more major changes over a long time, it isn't true. Some HPV infections result in HSIL right from the start; others stay low-grade for long periods; and others, like yours, may go quickly from low to high grade. This appears to be random, not because some HPV strains are more aggressive than others. It makes little or no difference in the risk for cancer, or when cancer might develop. Progression to overt (invasive) cancer usually takes 5-10 years, even in situations like yours.
In other words, your HPV infection is no more "aggressive" than normal. So follow your ObG provider's advice. Most likely s/he will recommend a colposcopy examination and perhaps a procedures to remove the diseased cervical tissue. Properly managed, there is almost no chance you ever will have actual cancer.
As for oral HPV and cancer, there is no reason to suspect you would be in the very small minority who will get it. For a more detailed discussion about oral HPV and cancer, please see this thread: http://www.medhelp.org/posts/show/758844
Bottom line: Follow your ObG's advice about follow-up and treatment of your abnormal pap smear, which will protect you against cervical cancer. Don't worry about oral cancer; it's not likely to ever be an issue for you.
Best wishes-- HHH, MD
First, as for your pap smear: I agree you probably have a high-risk type of HPV infection, based on having "high risk cells" Most likely that means your pap smear shows high-grade displasia or that a biopsy showed a "high grade squamous intraepithelial lesion", or HSIL. Although low-risk types cause many abnormal pap smears, they generally are limited to lower grade dysplasia or low grade SIL (LSIL).
However, neither that finding nor the apparent speed of progression is alarming at all. Although patients (and some doctors) often assume that paps progress from minor to more major changes over a long time, it isn't true. Some HPV infections result in HSIL right from the start; others stay low-grade for long periods; and others, like yours, may go quickly from low to high grade. This appears to be random, not because some HPV strains are more aggressive than others. It makes little or no difference in the risk for cancer, or when cancer might develop. Progression to overt (invasive) cancer usually takes 5-10 years, even in situations like yours.
In other words, your HPV infection is no more "aggressive" than normal. So follow your ObG provider's advice. Most likely s/he will recommend a colposcopy examination and perhaps a procedures to remove the diseased cervical tissue. Properly managed, there is almost no chance you ever will have actual cancer.
As for oral HPV and cancer, there is no reason to suspect you would be in the very small minority who will get it. For a more detailed discussion about oral HPV and cancer, please see this thread: http://www.medhelp.org/posts/show/758844
Bottom line: Follow your ObG's advice about follow-up and treatment of your abnormal pap smear, which will protect you against cervical cancer. Don't worry about oral cancer; it's not likely to ever be an issue for you.
Best wishes-- HHH, MD
MEDICAL PROFESSIONAL
STD specialists like me understand HPV transmission and early clinical manifestations. We do not manage cervical HPV infections or keep up to date on their treatment. You'll have to rely on your ObG about the first paragraph above.
That your cervical infection went to a high grade quickly says nothing at all about how HPV infections elsewhere on your body would behave. Even without anal sex, women with HPV of the cervix or genital area usually have it in the anus as well. A single episode of anal sex does not increase your already high chance of having anal HPV, and that in turn does not indicate a high risk of later anal cancer. Please don't worry about this. You don't need an anal pap smear.
That your cervical infection went to a high grade quickly says nothing at all about how HPV infections elsewhere on your body would behave. Even without anal sex, women with HPV of the cervix or genital area usually have it in the anus as well. A single episode of anal sex does not increase your already high chance of having anal HPV, and that in turn does not indicate a high risk of later anal cancer. Please don't worry about this. You don't need an anal pap smear.
MEDICAL PROFESSIONAL
HPV generally clears up at all infected sites over several months, although it can take up to two years for the high risk types.
I've been thinking and have one more follow-up question. When I see my OB/GYN in June for my first post-LEEP treatment follow-up pap smear, I am planning to also ask for a HPV test at the same time to see if my body has cleared the virus yet. I've read from other HPV related posts on this forum that once your body has cleared the virus, you are unable to transmit it to someone else. However, I've also read on this forum that the virus can be present on your skin (near the thigh and buttocks areas, etc...). So, even if my HPV pap test comes back negative, isn't it still possible to transmit the virus from skin-to-skin sexual contact since the virus may still be living on my skin? Or, does HPV usually clear the skin as well? As I am in a committed relationship, I don't see this as an issue now; however, if my situation would ever change, I would like to be able to give an honest answer to a future partner who asks about my STD history/status.
MEDICAL PROFESSIONAL
That's why we're here. You're welcome.
Great, you information helped ease my worries. Thank you for your forum; it is really a great resource, especially for those of us who may not have been completetly comfortable with the health care provider we have already seen.
Thank you for your help, Doctor. I actually already had my displaysia treated with a LEEP procedure about 3 weeks ago. However, I wanted to obtain a "second opinion" because, after researching online about standard treatment for cervical displaysia, I thought it was a little strange that my OB/GYN recommended a LEEP without first doing a biopsy. I am guessing that he did that because he said that on a scale from 1-5, 5 being the worst, I was at about a 4 or 4.5, meaning severe enough to act immediately. Would you agree?
Given that, I am very concerned because I am about 90% sure I contracted HPV from my current monogomous boyfriend since I was a virgin prior to this relationship. One night, when we were intimate, he accidentally inserted his penis into my anus. It was dark and an innocent mistake. However, I found it painful, and of course, yelled out for him to withdraw. From what I have read, it seems that those who have anal sex are just as at risk for anal cancer as women were prior to the pap smear being introduced. And, considering how my infection caused my cervical cells to turn "high-risk" so quickly, I am concered for the cells in my anus now that they have been in contact with my boyfriend's genitals. Do I need to go get an anal pap done? I've looked into this, but it doesn't seem to be offered in my city. I would have to drive about 5 hours to obtain one. Please advise.
Given that, I am very concerned because I am about 90% sure I contracted HPV from my current monogomous boyfriend since I was a virgin prior to this relationship. One night, when we were intimate, he accidentally inserted his penis into my anus. It was dark and an innocent mistake. However, I found it painful, and of course, yelled out for him to withdraw. From what I have read, it seems that those who have anal sex are just as at risk for anal cancer as women were prior to the pap smear being introduced. And, considering how my infection caused my cervical cells to turn "high-risk" so quickly, I am concered for the cells in my anus now that they have been in contact with my boyfriend's genitals. Do I need to go get an anal pap done? I've looked into this, but it doesn't seem to be offered in my city. I would have to drive about 5 hours to obtain one. Please advise.
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