HPV and Mild Lesions: A Patient's Journey in Gynecology

Papillomavirus and mild lesions?

Hello, doctor: I have a question that I hope you can clarify for me.
In August 2014, during the summer heat, I experienced itching in my intimate area and visited Clinic A (a general gynecology clinic, although it also provides obstetric services).
The doctor mentioned that summer often triggers candidiasis and prescribed an antifungal suppository.
The symptoms resolved, but during the examination, the doctor noticed something unusual about the skin in my intimate area and immediately performed a biopsy.
Later, I tried to call for the results, but the phone was always busy.
I thought that since the biopsy was done, they would notify me if there were any issues.
As I got busy with work, I eventually forgot about it.

In November 2015, I happened to visit Hospital B (a well-known hospital) where they were offering free Pap smears.
I remembered that I hadn’t received the results from the biopsy in 2014, which made me uneasy.
I decided to have a Pap smear done at Hospital B, and later received notification that there were no abnormalities, which relieved me.
In August 2016, I again experienced candidiasis due to the summer heat and returned to Clinic A for treatment.
In addition to prescribing the antifungal suppository again, the doctor presented the 2014 biopsy report indicating a viral infection, specifically human papillomavirus (HPV).
I was very anxious at that moment because this is serious, and I was also angry that I had not been informed about the viral infection.
Even though I had forgotten due to work, I was eager to resolve the issue and did not pursue accountability.
Clinic A performed cryotherapy on me (the lesions were minimal).

However, I am puzzled: if the 2014 biopsy showed an issue, how could the Pap smear in 2015 show no abnormalities? If the biopsy had problems, wouldn’t the Pap smear be more likely to show issues? After the cryotherapy, there have been no new lesions, and the wound has healed well, but I am still very worried.
I have been regularly returning to Clinic A for follow-ups and ultrasounds.
I also had a Pap smear done this year in 2016, but this time the report raised concerns about significant cervical dysplasia, although the biopsy later indicated mild dysplasia.

Please help clarify my concerns, as I am about to get married.
I am worried about whether this will affect my fertility.
Can HPV be completely cured? This situation makes me question the professionalism of Clinic A for not informing me about the viral infection.
I have now made an appointment with the gynecology department at Hospital B.
I can only try to stay relaxed and boost my immune system while waiting for my appointment, treating it as a pre-marital health checkup.

Xiao Yi, 30~39 year old female. Ask Date: 2016/11/08

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the current treatment methods for human papillomavirus (HPV) warts include various options such as cryotherapy, electrosurgery, topical medications, and laser therapy.
These treatments are limited to removing visible warts and do not completely eradicate the virus, with a recurrence rate of approximately 20%.
It is important to follow the prescribed treatment regimen.
Generally, patients who receive appropriate treatment can effectively manage the genital warts virus without causing significant harm to their health.
However, during pregnancy, it is essential to assess for excessive lesions in the genital tract and choose an appropriate delivery method to avoid vertical transmission to the newborn.
Patients can try the following methods to alleviate symptoms and prevent infecting sexual partners: 1.
Keep the genital area clean and dry.
2.
Avoid using scented soaps or bath oils to prevent irritation of wart-prone areas.
3.
Condoms can reduce the risk of transmission, but if the infected area is located on other parts of the body, such as the scrotum, condoms may not provide protection.
4.
It is recommended for regular sexual partners to undergo cervical cancer screenings to mitigate severe complications.
5.
Maintain a healthy lifestyle, including a balanced diet, regular exercise, and strengthening the immune system, to reduce the chances of recurrence.
6.
The prognosis for HPV warts is generally good, but the recurrence rate is relatively high.
7.
There are vaccines available for prevention, but they cannot be used for treatment.
8.
With combined treatment and healthy behaviors, there is a possibility for the virus to clear, which should be evaluated by a physician.
Thank you! Wishing you peace and health.
Dr.
Chang

Reply Date: 2016/11/08

More Info

Understanding HPV and Mild Lesions: A Patient's Journey in Gynecology
Human Papillomavirus (HPV) is a common sexually transmitted infection that can lead to various health issues, including cervical dysplasia, which is a precancerous condition. Your journey through the healthcare system, from experiencing symptoms to receiving a diagnosis and treatment, highlights the complexities of managing HPV-related conditions and the importance of communication between patients and healthcare providers.

Firstly, it is essential to understand that HPV is a diverse group of more than 100 different types of viruses, with some classified as high-risk due to their association with cancer, particularly cervical cancer. The fact that you had a previous diagnosis of HPV and mild dysplasia indicates that your body was responding to the virus, which is common. Many individuals with HPV will clear the virus naturally within two years without any intervention. However, persistent infections with high-risk HPV types can lead to cellular changes, such as mild dysplasia (CIN1), moderate dysplasia (CIN2), or severe dysplasia (CIN3), which may require closer monitoring or treatment.

Your experience with the initial diagnosis and the subsequent lack of communication regarding the results is concerning. It is crucial for healthcare providers to inform patients about their test results, especially when it involves potential risks for cancer. This communication is vital for patients to understand their health status and make informed decisions about their care. In your case, the delay in receiving information about your HPV status could have caused unnecessary anxiety and confusion.

The fact that your Pap smear results were normal after the biopsy raises an interesting point. Pap smears are designed to detect abnormal cervical cells, but they may not always correlate directly with biopsy results. A biopsy is a more definitive test that examines the tissue for dysplastic changes. It is possible for a Pap smear to be normal while a biopsy shows mild dysplasia, as the two tests assess different aspects of cervical health. This discrepancy can occur due to the timing of the tests, the area sampled, or the natural progression of HPV-related changes.

Regarding your concerns about fertility and the impact of HPV on your future plans, it is reassuring to know that mild dysplasia (CIN1) typically does not pose a significant risk to fertility. Most women with mild dysplasia can conceive and have healthy pregnancies. However, it is essential to continue regular follow-ups with your healthcare provider to monitor any changes in your cervical health, especially as you prepare for marriage and potential pregnancy.

Treatment for mild dysplasia often involves monitoring rather than immediate intervention. In many cases, healthcare providers recommend a watch-and-wait approach, with follow-up Pap smears and HPV testing every six months to a year. If the dysplasia does not resolve or worsens, more invasive treatments, such as excisional procedures (e.g., LEEP or conization), may be considered.

As for your question about whether HPV can be cured, it is important to note that while the virus itself may not be eradicated from the body, most individuals will clear the infection naturally over time. The immune system plays a crucial role in controlling and eliminating HPV. Maintaining a healthy lifestyle, managing stress, and possibly considering HPV vaccination can help boost your immune response.

In conclusion, your journey through the diagnosis and management of HPV and mild dysplasia underscores the importance of clear communication with healthcare providers, regular monitoring, and understanding the natural history of HPV infections. It is commendable that you are taking proactive steps to manage your health as you approach a significant life event. Continue to engage with your healthcare team, ask questions, and advocate for your health as you navigate this journey.

Similar Q&A

Understanding HPV and Mild Cervical Dysplasia: What You Need to Know

Hello Dr. Wu, I am inquiring on behalf of my girlfriend. On October 13, she underwent a human papillomavirus (HPV) test and Pap smear at a clinic. During her follow-up appointment on November 3, the results showed positive for HPV type 56 (high-risk) and type 6 (low-risk). The di...

Dr. Wu Xianghui reply Obstetrics and Gynecology
1. For more details, please refer to the website of the Health Promotion Administration at https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=205&pid=11252. There are reimbursement regulations related to health insurance for relevant examinations. 3. It is recommended to bring t...

Unraveling Uncertainty: Understanding Vaginal Lesions and Their Causes

Hello Dr. Lin, In January of this year, I developed a couple of small, bump-like lesions on both sides of my labia and the inner labia, similar in size to heat rash. They are neither painful nor itchy. Having lived abroad for a long time, I don't have access to the same he...

Dr. Lin Manying reply Obstetrics and Gynecology
It is not possible to determine whether the lesions on your vulva are genital warts; it is best to have a physician perform a visual examination and conduct a biopsy.

Understanding HPV Screening: Discrepancies Between Virus Types and Lesions

In July of this year, I discovered a protrusion on my vulva. After consulting a doctor, it was suspected to be genital warts, and I was prescribed Aldara (imiquimod) to apply. Within a week, it disappeared and healed, but to be cautious, I had a biopsy done (there was also a susp...

Dr. Zhang Kunmin reply Obstetrics and Gynecology
Hello, based on your description, you can have another HPV test and confirm the biopsy report with your treating physician. If HPV is still present, there is a possibility of transmission through intimate contact. Thank you! Wishing you peace and health, Dr. Chang.

Understanding HPV and Genital Warts: A Patient's Journey

Hello doctor, I was diagnosed with genital warts this month. Due to my menstrual period, I am currently unable to undergo surgery. My last sexual encounter was in December 2016. In May 2017, I had an HPV test which showed types 39, 59, 66, and 42. I asked my doctor if these could...

Dr. Huang Jianzhong reply Obstetrics and Gynecology
This month, I was diagnosed with genital warts. Due to my menstrual period, I am currently unable to undergo surgery. However, my last sexual encounter was in December 2016. In May 2017, I had an HPV test which showed types 39, 59, 66, and 42. I asked my doctor if these would cau...