Q- pap was negative, but high risk hpv dna was positive

[Anonymous]

15 yrs ago I had HPV and a class 3 pap-it was treated successfully- Post treatment, I had a colposcopy at a cancer center which showed nothing on my cervix. I have had annual paps since then which were all negative. I just had a pap 6 months after my baby and while the pap was negative (old class one) the HPV part of the test showed "high risk dna positive"". The MW said I just need to continue to have annual paps, when I googled it, it seems that all the info I found was on how important it is to get the screening- there was nothing about what it means/what is recommended if the screen is positive.
During my labor with this last baby, my cervix was kind of having a tough time dilating past a certain point until the MW checked me and sort of broke up some adhesions. She asked me later if I had had a bad pap since my prior delivery because it seemed to her to feel like how it is when woman had had a colposcopy or something. (I have had 2 deliveries between the colpo 15 yrs ago, and this last baby).
its not really playground chit chat, and I am wondering where to get more info, or if anyone else has had this? Thanks.

[Anonymous]

I have not had this and can not answer all your questions, but I CAN tell you one thing that stuck out like a sore thumb in your post.....annual paps from now on? NO WAY! You should now be on a much more closely monitored schedule of paps every 3 months in my opinion.

I have had numerous hpv dna tests (all negative thankfully) as a result of fairly common abnormal paps. My doctor automatically goes to paps every 3 months until you have 3 normal in a row after an abnormal result. We talked about possible hpv positive results at one point and he told me when it shows a positive for high risk dna you need to be checked every 3 months from then on. In his opinion (and mine) it is simply too high risk to not be overly cautious when it comes to catching something in early stages. To go a year between paps is just too long.

I don't want to scare you - only 15% of high risk dna positive results go onto cancer, but if paps a few times a year can catch something early wouldn't it seem right to do so?

[Anonymous]

OP here- Thank you-- I felt like continuing on the annual plan seemed pretty laid back. I think I will make an appt with a gyn onc for a second opinion and schedule. I was on every 3 month paps, and then every 6 month paps for a couple of years after the initial abnormal one 15 years ago. Thanks for your input.

[Anonymous]

Really don't be scarred. Testing positive on the HPV is very common. The best thing to do is to continue having regular pap smears so they can treat any abnormalities early on. As long as your pap smear was normal, I don't think you need a pap more frequently than once per year. More and more women are now going to test positive because of the new pap smears. Hopefully, the HPV vaccine will soon be approved for women who did test positive on the HPV screen. I read somewhere that it was extremely effective with few adverse effects. However, i think it's currently only recommended for women who have negative HPV tests but I could be wrong.

[Anonymous]

OP again- I spent a few hours last night researching and here is what I have found. I am posting in case anyone else looks up in the archive later.
There is not totally clear concensus but it looks like the 2006 guideline from the american society of colposopy and cervical pathology aka ASCCP as printed in the oct 07 Journal of Obstetrics and Gyn recommend: with cytology neg and hpv pos -rec repap and cytology in 12 mos. If positive , than colposcopy.
BUT women with high risk HPv who are 30 yrs old plus, have a 18-21 % chance of CIN 3 within 10 yrs of follow up.So recommendation in cytology neg, high risk hpv positive is to be referred for colposcopy (AJOG 10-07).
*note- they refer to "specific high risk types such as 16, 18" and say that "other high risk types would repap and recytology in 12 months"
Also- the fact that I had an abnormal pap 15 yrs ago means it is highly unlikely that the HPV DNA will spontaneously"clear" (since it has not already in that time period) so waiting to repap is not likely to show a change in 6-12 months.

It appears that as a 40 year old I fall into an "older women: group (GASP!) and here is the stats re: cervical cancer among that group with normal paps and high risk HPV positive DNA:
Among older women(40-50 years old) where HPV may be added to general screening, the estimated absolute risk of ?CIN3 in HC2-positive women was more than 20% within 10 years. These results indicate that even a single positive HPV test in cytologically negative women is substantially predictive of high-grade CIN and suggest that HC2 testing can help stratify women into different risk categories. (Cancer Res 2006; 66(21): 10630-6)
* HC2 test is the name of one of the HPV DNA tests
The long and short answer is a second opinion is needed.
The odds of a greater than CIN3 pap (aka- cancer) is greater than 20% for me in the next ten years. I love my MW, but think her recommendation was very off base.
As my husband said- "I'd buy a lotto ticket with those odds- yes- lets pursue other opinions!"

[Anonymous]

[During my labor with this last baby, my cervix was kind of having a tough time dilating past a certain point until the MW checked me and sort of broke up some adhesions. She asked me later if I had had a bad pap since my prior delivery because it seemed to her to feel like how it is when woman had had a colposcopy or something. (I have had 2 deliveries between the colpo 15 yrs ago, and this last baby).
]
I had the same experience with my first baby. I had been completely effaced for weeks, my water had broken and I was still only one centimeter dialated. The OBGYN examining me asked if I had had any surgeries because she felt a scar (I also had a colposcopy)when I told her yes i'd had she broke up the scar tissue and said "there, now you're 2 cenimeters dialated"! I couldn't believe it..at least 4 outher MD"s had examined me (some multiple times) and never mentioned it.