Normal HPV Test but Still Have Warts? the Discrepancy

A normal HPV smear but presence of warts?

Hello, doctor.
In September, I discovered cervical erosion and noticed a few small growths in the genital area.
After visiting Clinic A, the doctor examined the growths and said they were nothing to worry about.
I also had an HPV Pap smear done, and the report came back normal.
However, when I went to Clinic B in October for the cervical erosion issue, the doctor said those small growths were warts.
I would like to ask why the HPV report was normal if it did not detect the presence of warts?

Qian, 20~29 year old female. Ask Date: 2020/10/12

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, based on your description, a definitive diagnosis cannot be confirmed.
The identification of warts relies on the appearance of the lesions, the location of the infection, and confirmation through biopsy of the lesions.
Thank you! Wishing you peace and health.
Dr.
Zhang

Reply Date: 2020/10/12

More Info

The situation you described raises important questions about the relationship between HPV testing, the presence of warts, and the complexities of HPV infections. Let's break down your concerns and provide a comprehensive understanding.

1. Understanding HPV Testing: HPV tests are designed to detect the presence of high-risk HPV types that are associated with cervical cancer. However, these tests may not detect all types of HPV, particularly low-risk types that cause genital warts (such as HPV types 6 and 11). Therefore, it is possible to have a normal HPV test result while still having warts caused by low-risk HPV types. The HPV test you underwent likely focused on high-risk strains, which could explain why the test returned normal results despite the presence of warts.

2. Presence of Warts: The small growths you mentioned, which were later identified as warts (or condylomata acuminata), are typically caused by low-risk HPV types. These types do not usually lead to cervical cancer but can cause visible warts. The fact that your HPV test was normal indicates that the strains tested for were not present in your system at detectable levels, but it does not rule out the presence of low-risk HPV types that cause warts.

3. Discrepancy Between Tests: The discrepancy between the normal HPV test and the diagnosis of warts can be attributed to the specific types of HPV being tested. As mentioned earlier, standard HPV tests often focus on high-risk types associated with cervical cancer. If the warts are caused by low-risk types, they may not be detected in a standard HPV test. This is a common scenario and highlights the importance of understanding the limitations of HPV testing.

4. Management of Warts: If you have been diagnosed with genital warts, treatment options are available. These can include topical treatments, cryotherapy, or other procedures to remove the warts. It is essential to discuss these options with your healthcare provider, especially if the warts are causing discomfort or concern.

5. Preventive Measures: To reduce the risk of HPV transmission and the development of warts, vaccination is highly recommended. The HPV vaccine can protect against the most common high-risk and low-risk HPV types, including those that cause warts. Even if you have already been diagnosed with HPV, vaccination can still provide protection against other strains.

6. Follow-Up Care: Regular follow-up with your healthcare provider is crucial, especially if you have a history of cervical abnormalities or warts. This ensures that any changes in your condition are monitored and managed appropriately.

7. Communication with Partners: It's also important to communicate with your sexual partners about HPV and the potential for transmission. While using condoms can reduce the risk of HPV transmission, it does not eliminate it entirely, as HPV can be present in areas not covered by a condom.

In summary, a normal HPV test does not necessarily mean that you are free from all HPV infections, particularly low-risk types that cause warts. It is essential to have open discussions with your healthcare provider about your specific situation, treatment options for warts, and preventive measures to protect your health and that of your partners. Regular screenings and vaccinations are key components in managing HPV-related health concerns.

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