HPV: What to Do After Abnormal Pap Smear Results

Human Papillomavirus (HPV)

Hello Dr.
Lu,
I would like to ask you a few questions.
I had a Pap smear on October 4th, and on October 11th, I was notified by phone that the results were abnormal and I needed to return for a follow-up.
During the follow-up, I was informed that my Pap smear showed a mild presence of HPV type 6.
I was then advised to undergo further testing for human papillomavirus (HPV), and on October 19th, I received a call stating there was an issue with the HPV test.
When I returned for my appointment, the report indicated high-risk types 52+ and 66+.
I asked the doctor what to do next, and they said I have two options: either repeat the HPV test in 4 to 6 months or go directly to a major hospital for a colposcopy.
I am very worried and unsure how to proceed.
I have read online that HPV types 52+ and 66+ are concerning, and I have several questions:
1.
Why did my initial Pap smear indicate a mild presence of HPV type 6, but the subsequent HPV test showed high-risk types 52+ and 66+?
2.
I have not had sexual intercourse since giving birth in 2009 and did not have any Pap smears until October 4th of this year.
How could I have contracted high-risk HPV?
3.
The obstetrician-gynecologist suggested I could go to a major hospital for a colposcopy.
What does this procedure involve, and are there any treatment options available after the colposcopy?
4.
How should I handle my current situation? I hope you can provide me with some advice, as I am feeling very anxious and scared.
I do not have any unusual discharge and am currently not sexually active.
I would greatly appreciate your guidance.
Thank you very much.

zero zero, 30~39 year old female. Ask Date: 2016/10/21

Dr. Lü Lizheng reply Obstetrics and Gynecology

The presence of the virus is actually quite common.
According to studies conducted abroad, more than half of women have had the virus at some point.
Although the virus may be present, most individuals will develop antibodies over the years, gaining immunity, and the virus will disappear, posing no danger.
However, a small number of individuals do not develop antibodies, and the virus remains, requiring more caution.
It is important to remember to have annual Pap smears and consider annual viral screening to check for the presence of the virus.
If a colposcopy is performed, the results are likely to be normal.
In a small number of cases where abnormalities are detected, a cervical biopsy can be performed on-site.
Even if abnormalities are found, they are usually just early lesions, and only a very small percentage are cancerous.
Further surgical treatment is only necessary if cancer is diagnosed.
Even in cases of early lesions, it is very likely that they will resolve on their own, and regular follow-up is typically sufficient.

Reply Date: 2016/10/21

More Info

Understanding HPV and the implications of abnormal Pap smear results can be quite overwhelming, especially when faced with the possibility of high-risk strains of the virus. Let's break down your concerns and provide clarity on the next steps.

1. Understanding Your Pap Smear Results
Your initial Pap smear indicated "mild abnormalities" (often referred to as ASC-US), which can sometimes be associated with HPV infection. The subsequent HPV test revealed high-risk types 52 and 66. It’s important to understand that HPV is a very common virus, and many individuals will be exposed to it at some point in their lives. Most of the time, the immune system clears the virus without any intervention. However, certain high-risk types, like HPV 52 and 66, can lead to cervical changes that may progress to cervical cancer if not monitored or treated appropriately.

2. Why the Change in Results?
The transition from a mild abnormality to a high-risk HPV result can be confusing. The initial Pap smear may not have detected the presence of high-risk HPV, or the viral load may have been low at that time. HPV testing is more sensitive than Pap smears, which is why it can identify high-risk strains that may not have been evident during the initial screening. Additionally, HPV can remain dormant for years, so it’s possible to test negative for HPV at one point and then positive later.

3. Next Steps: Colposcopy vs. Monitoring
Your doctor has provided you with two options: either wait and retest for HPV in 4-6 months or proceed directly to a colposcopy. A colposcopy is a procedure that allows the doctor to closely examine your cervix using a special magnifying instrument. This is typically recommended when there are abnormal Pap results or high-risk HPV findings. During the colposcopy, if any abnormal areas are identified, a biopsy can be performed to determine if there are any precancerous changes or cancer.

4. Treatment Options
If the colposcopy reveals abnormal cells, treatment options may include:
- Observation: If the changes are mild, your doctor may recommend monitoring.

- Cryotherapy: Freezing abnormal cells.

- LEEP (Loop Electrosurgical Excision Procedure): Removing abnormal tissue for further examination and treatment.

- Cone biopsy: A more extensive procedure to remove a larger area of cervical tissue.

5. Addressing Your Concerns
It’s understandable to feel anxious about your diagnosis, especially with the implications of high-risk HPV. Here are some points to consider:
- No Sexual Activity: HPV can remain dormant for years, and it’s possible to contract it from a previous partner. The virus does not necessarily require recent sexual activity to be present.

- Follow-Up Care: Regular follow-up is crucial. If you choose to have a colposcopy, it will provide more definitive information about your cervical health.

- Support: Consider discussing your feelings and concerns with a healthcare provider or counselor who can provide emotional support during this time.

Conclusion
In summary, the presence of high-risk HPV types necessitates careful monitoring and possibly further investigation through a colposcopy. It is essential to follow your healthcare provider's recommendations and maintain regular screenings. Remember, early detection and treatment of any cervical changes can significantly reduce the risk of developing cervical cancer. If you have further questions or concerns, do not hesitate to reach out to your healthcare provider for more personalized guidance.

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