I see that the general consensus on clearance/suppression of HR/LR HPV for a person with a normal immune system is 6-24 months.
Is that from initial exposure or upon finding out that a person has an active HPV infection?

Some women have HPV for 5, 10, and even 20 years without having cervical cell changes (excluding new exposure). What's going on there? Would they have tested negative for HPV during the dormant period?

Some women also test positive for HPV for years while having normal pap smears. If HPV DNA can be tested by hybrid capture, it means your cervical cells are shedding HPV affected cells, right? Then, how come these women have normal paps without cervical cell changes? Is it because pap smear isn't sensitive enough and/or pap smear brush often does not sample areas that are affected?

Does anyone know if HPV 16 and 18 are the types that persist?
Are they more prevalent in the general population?

I've been going through HPV forums, and there are definitely women who suffer from persistent cervical issues. Their bodies did not clear HPV within 2 years of infection or discovery. Even if HPV does not cause cancer, it seems to cause recurrent abnormal cell changes that some people have to have REPEAT procedures. Are the majority of these cases caused by HPV 16 and 18? There must be a study or a literature on this. Know of any prestigious publications on HPV?

Does the doctor examine the vulva area during colposcopy?

How do I get my oropharyngeal area examined for HPV lesions?

Knowing that having HPV increases my chances of getting head and heck, vulva, cervical, and anal cancers, I would like to watch out for changes in and on my body just in case. How do I do that?

Thanks.

I see that the general consensus on clearance/suppression of HR/LR HPV for a person with a normal immune system is 6-24 months. Is that from initial exposure or upon finding out that a person has an active HPV infection?

FROM CONTRACTION OF THE VIRUS UNTIL CLEARANCE. THIS IS A TYPICAL TIME FRAME, BUT CAN VARY WIDELY AND ACTUALLY SPAN WEEKS, MONTHS, YEARS, DECADES.

Some women have HPV for 5, 10, and even 20 years without having cervical cell changes (excluding new exposure). What's going on there? Would they have tested negative for HPV during the dormant period?

THEY PROBABLY DO HAVE CELL CHANGES AT SOME POINT, BUT KEEP IN MIND MOST HPV-RELATED CHANGES REGRESS SPONTANEOUSLY. A WOMAN WITH PERSISTENT HPV INFECTION OF THE TIME FRAME YOU MENTION WOULD PROBABLY TEST POSITIVE ON MOLECULAR TESTS.

Some women also test positive for HPV for years while having normal pap smears. If HPV DNA can be tested by hybrid capture, it means your cervical cells are shedding HPV affected cells, right? Then, how come these women have normal paps without cervical cell changes? Is it because pap smear isn't sensitive enough and/or pap smear brush often does not sample areas that are affected?

HERE TOO, THEY PROBABLY HAD CHANGES AT SOME POINT THAT MAY HAVE RESOLVED, OR PERHAPS THE CYTOLOGY SIMPLY DIDN'T DETECT THEM. PAPS DONE AT REGULAR INTERVALS WILL USUALLY DETECT PERSISTENT CELL CHANGES WELL BEFORE CANCER DEVELOPS, THOUGH.

Does anyone know if HPV 16 and 18 are the types that persist?
Are they more prevalent in the general population?

NOT NECESSARILY MORE PREVALENT (ONE CDC STUDY SHOWED THEY WEREN'T) BUT GREATER ONCOGENIC POTENTIAL, ESPECIALLY HPV 16.

I've been going through HPV forums, and there are definitely women who suffer from persistent cervical issues. NO DOUBT, THIS IS NOT THE NORM BUT NOT AT ALL UNHEARD OF.
Their bodies did not clear HPV within 2 years of infection or discovery. Even if HPV does not cause cancer, it seems to cause recurrent abnormal cell changes that some people have to have REPEAT procedures. SOME PEOPLE DO, YES. Are the majority of these cases caused by HPV 16 and 18? YES, HPV 16 ESPECIALLY IS MORE LIKELY THAN OTHER TYPES TO PERSIST.There must be a study or a literature on this. Know of any prestigious publications on HPV? ENDLESS ARTICLES OUT THERE, I'LL POST A COUPLE OF ABSTRACTS.

Does the doctor examine the vulva area during colposcopy? NO GUARANTEE THIS GETS MUCH/ANY ATTENTION IF THE IMPETUS FOR THE COLPOSCOPY IS CERVICAL EVALUATION.

How do I get my oropharyngeal area examined for HPV lesions? YOUR DENTIST CAN EXAMINE YOU, USUALLY.

Knowing that having HPV increases my chances of getting head and heck, vulva, cervical, and anal cancers, I would like to watch out for changes in and on my body just in case. How do I do that? THERE'S NO PROTOCOL ON ASYMPTOMATIC SCREENING, REALLY, EXCEPT HAVING YOUR DENTIST OR MAYBE PRIMARY CARE CLINICIAN VISUALLY INSPECT THE AREA. UTILITY OF CLINIC-BASED ORAL HPV TESTING IS CONTROVERSIAL AND UNKNOWN. NOT SAYING DON'T DO IT, JUST AN EMERGING FIELD AND NOT WIDELY AVAILABLE.

CONSIDER TOO, THAT HEAD AND NECK CANCERS ARE NOT TERRIBLY COMMON, AND HALF OR FEWER ARE HPV-RELATED (AND THE HPV H&N DISEASES TEND TO HAVE BETTER OUTCOMES, FOR SOME REASON).

Thanks.


Titre du document / Document title
Human papillomavirus genotype distribution in high grade cervical lesions (CIN 2/3) in France : EDITH† study
Auteur(s) / Author(s)
EDITH study group, FRANCE
PRETET Jean-Luc (1) ; JACQUARD Anne-Carole (2) ; CARCOPINO Xavier (3) ; MONNIER-BENOIT Sylvain (1) ; AVEROUS Gerlinde (4) ; SOUBEYRAND Benoit (2) ; LEOCMACH Yann (2) ; MOUGIN Christiane (1) ; RIETHMULLER Didier (1) ;
Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)
(1) EA3181, IFR133, CHU Besançon, FRANCE
(2) Sanofi Pasteur MSD, Lyon, FRANCE
(3) CHU Nord, Marseille, FRANCE
(4) CHU Strasbourg, FRANCE
Résumé / Abstract
High grade cervical intraepithelial neoplasia (CIN 2/3) have a high potential to progress to invasive cervical cancer (ICC). Pap testing including follow-up and treatment of CIN 2/3 is currently the best prevention of ICC, but is associated with morbidity, namely obstetrical adverse effects and psychological distress. Human papillomavirus (HPV) is universally accepted as the necessary cause of ICC. The objective of the present study was to describe the type-specific prevalence of HPV in CIN 2/3 in France and hereby to locally estimate the potential benefit of an HPV 16/ 18 L1 virus-like particles (VLP) vaccine. A total of 493 formalinfixed and paraffin-embedded CIN 2/3 specimens were analyzed. Medical records were examined for patient related data. HPV were genotyped with the INNO-LiPA assay allowing the detection of 24 HPV genotypes. The overall prevalence of LiPA detectable HPV was 98%. The most prevalent genotype was HPV 16 (62%) followed by HPV 31 (15%), 33 (12%), 52 (9%), 51 (8%), 58 (7%), 35 and 18 (4%). Multiple infection with at least two different high-risk (HR) HPV genotypes was observed in 26% of all specimens including 2.6% with HPV 16 and 18 multiple infections. The present study indicates that HPV 16 is by far the most common HPV type associated with CIN 2/3 in France. With an HPV 16 and 18 prevalence of 64%, HPV 16/18 L1 VLP vaccines would be expected to significantly reduce the burden associated with the management and treatment of CIN 2/3 in France.

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ASHA Moderator

Thanks Fredo for your detailed and erudite response!

I've been reading HPV related abstracts on PubMed, but I thought I should consult an expert.

Even if an oral screening test for HPV detects HPV DNA in your mouth, there is no treatment for it at this time, right?

I understand that men are symptomless. If their female partners have HPV 16 or 18, what should they do? I'm guessing since partners share HPV strains, the men are at risk of developing penile, H&N, and anal cancers. Any diagnostic tests for detecting HPV related cancers, precancerous changes, or HPV DNA in your body other than pap smear?

Therapeutic HPV vaccines developing any time soon?

I know all these cancers are rare, but I'm considering all my options.
I just found out that I have HPV because of an abnormal pap.

Thx again.

Thanks Fredo for your detailed and erudite response! ALL CREDIT GOES TO THE ASHA TRAINING MANUAL AND MY HIGH SCHOOL ENGLISH TEACHER.

I've been reading HPV related abstracts on PubMed, but I thought I should consult an expert. THEN WHY ARE YOU TALKING TO ME?

Even if an oral screening test for HPV detects HPV DNA in your mouth, there is no treatment for it at this time, right? CORRECT, NO TREATMENT INDICATED FOR HPV, JUST FOR SOME OF THE LESIONS IT CAN CAUSE (NOT ALL LESIONS REQUIRE THERAPY). HENCE THE RESTRAINT WITH CLINICAL USE OF HPV DNA TESTS...LOTS OF NEEDLESS ANXIETY CREATED WITH NO MEDICAL BENEFIT IN MANY CASES.

I understand that men are symptomless. If their female partners have HPV 16 or 18, what should they do? NOT MUCH THEY CAN DO, REALLY, AS DISCUSSED ABOVE. VISUAL INSPECTION OF THE ANOGENITAL AREA, PERHAPS, BUT NO HPV TESTING AS A ROUTINE MATTER. I'm guessing since partners share HPV strains, the men are at risk of developing penile, H&N, and anal cancers. Any diagnostic tests for detecting HPV related cancers, precancerous changes, or HPV DNA in your body other than pap smear? ANAL PAP TESTS CAN BE DONE, USUALLY IN "HIGH RISK" POPULATION SUCH AS THOSE, OBVIOUSLY, WHO ENGAGE IN RECEPTIVE ANAL SEX. EVEN THEN IT'S SOMEWHAT CONTROVERSIAL AND IT ISN'T CLEAR HOW EFFECTIVE THIS IS IN PREVENTING ANAL CANCER...ANAL CANCER IS NOT TERRIBLY COMMON, BUT IS ESPECIALLY A CONCERN FOR THOSE WHO ARE HIV+. GAY MEN, SADLY, HAVE MUCH HIGHER RATES THAN THE GENERAL POPULATION.

Therapeutic HPV vaccines developing any time soon? FINGERS CROSSED. A NUMBER ARE IN DEVELOPMENT, NO ONE SEEMS TO KNOW SPECIFICALLY IF/WHEN.

I know all these cancers are rare, but I'm considering all my options. SURE, GOOD TO ASK QUESTIONS.

I just found out that I have HPV because of an abnormal pap. AH, OK, MAKES SENSE YOU'RE SEEKING INFO. GOOD FOR YOU IN DOING SO. ARE THEY RECOMMENDING TREATMENT, OR JUST MORE FREQUENT FOLLOW-UP EXAMS?

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ASHA Moderator

A colposcopy exam is scheduled for me. I talked to two nurses from the ObGyn office, but I am still not sure about my pap result. The first nurse said that pap showed inflammation/abnormality and that my HPV test came back positive. I guess an HPV test was performed when my pap came back abnormal (that's the protocol I assume). When I asked the second nurse about Bethesda system, she was clueless and ignorant about most things.

Their cursory attitudes really turned me off. They were annoyed with my questions. I've never had any health issues let alone gynecological issues so I was surprised but calm when I got the result. One nurse spouted sexual mores when I asked her basic questions. I wanted to know what my partner and I should do now that we have HPV. Sigh. I had to educate myself online regarding HPV and cervical dysplasia. I'm thankful for this forum.

When I talk to the doctor, I'll be thorough.

I've not engaged in anal sex, but I was under the impression that HPV induced anal cancer can develop without engaging in anal sex.

I was reading MedHelp forums, and I think one of the doctors (Dr. Handsfield I believe, a board member of ASHA) mentioned that HPV lives on the skin and affects a wide area including the buttocks. Inevitably during sexual intercourse, anal region can come in contact with body parts that are affected with HPV, and HPV can get inside the body.

I know of someone who was treated for HPV induced anal cancer though I do not know about her sexual practices. She had to go through radiation and chemotherapy.
She may be an outlier, but who knows? I have no control over my genes or epigenome.

I'm not terribly worried, but this is an annoyance for sure. Now that I'm ready to start a family, I get an abnormal pap.

I found out that my pap smear result did come back ASC-US.

The colposcopy exam was a glorified pap smear and only took 10 min. even with biopsy and ECC. BTW, it was painless.
My doctor biopsied two places that had mild changes after acetowhite staining.
I hope that acetowhite staining was nonspecific. Maybe my biopsy result will be negative for dysplasia. Hah! I can hope!

Unless the biopsy result says otherwise, I just have to go back for a pap smear in 6 months. Watchful waiting it is!

She said 70% women she sees end up on the colposcopy table because of abnormal paps.

While the normative aspect of HPV and Colposcopy is comforting, the whole experience is disconcerting, and I am usually imperturbable.
I'll update my biopsy results in a week.

Reading the posts here really prepared me for the procedure and helped me to ask pertinent questions to the doctor.

Many thanks,

Thanks Noria, it's good to hear from you and we'll look forward to an update soon. Even though HPV is very common (most everyone has it at some point) and the Pap/colpo procedures are hardly exotic, you are absolutely right in that it's all very disconcerting. The diagnosis usually comes out of nowhere and it's hard to know how to react.

I'm glad you found this forum. Please visit often.

Fredo

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ASHA Moderator

This thread has some of the most useful information I have read on the forum so far. Thank you Noria for your thorough research and intelligent questions and Fredo for your informative replies. I have the same concerns as you, Noria, and was totally blindsided by my diagnosis of ASC-US and high-risk HPV. My colposcopy was today and am waiting for the results as well. Best wishes to you for your results.

Thanks Fredo.

Best wishes to you too, guest1234! Thank you for the compliment.

This whole experience caught me off guard indeed. I was planning on getting pregnant within two years or so, and I thought I was uber healthy.

ECC came back clear, but outer cervical biopsies showed mild dysplasia so I was told to come back for a pap in 6 months. In the mean time, it's "watchful waiting." I will update my pap result in 6 months.

I hope dysplasia regresses. I read some articles connecting folate levels and cervical dysplasia so I started taking folic acid supplements (well, I planned on taking them anyway as prenatal vitamins). I already eat and live healthy so I can only wait for the next pap and hope for good results.

UPDATE:

I just got my 6-month follow-up repap result. I'm thrilled.

My pap result was normal. The nurse who called me was happy for me.
I just have to go back and get another pap smear in Jan.

A normal pap result does not necessarily mean HPV is gone, but I am glad that my cervical cells are doing well.

Best wishes everyone!

Thanks for sharing that! What a great update. Good to hear from you and wonderful that you're doing so well.

Best,
Fredo

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ASHA Moderator

noria - that is great news! Best wishes for continued normal follow-ups!

UPDATE:

Hello everyone,

My pap result is abnormal again. The result was LSIL, and I had to get another colposcopy done but opted not to get a biospy as the doctor did not seem very concerned after looking at the effects of acetowhitening and Lugol's solution on my cervix. I will get another pap smear in 4 months or so.

It looks like I'll be struggling with HPV for a while.
The resurgence of HPV might be due to being extremely stressed. Weaker immune system?

When I asked the doctor when I can expect to "clear" HPV out of my system, and she told me I should try having a baby!
She said giving birth might reverse cervical dysplasia. =D

Keep us posted, if you don't mind. Glad to hear your doctor isn't really concerned...always a good thing!

Stress might play a role...I don't know. Not sure if anyone has looked at that specifically with HPV, but anything that overtaxes you and your immune system might be something to think about. Getting enough sleep and rest, eating right, finding ways to be good to yourself and relax, probably a good idea! That's easy for me to say, huh, as I work my way through six diet sodas and cups of coffee a day, hunched over a keyboard under a florescent light! Oh the humanity....

Post anytime, always good to hear from you!

Fredo

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ASHA Moderator