Pap Smear, HPV Testing, and CIN1 Results in Women's Health

Q: Pap Smear, HPV Testing, and CIN1 Results in Women's Health

Regarding your concerns, here are the responses in order：<br>Q1. <br>Is an undetectable HPV test result considered negative? Does it mean there is no infection with any high-risk or low-risk human papillomavirus?<br>A1. <br>The term "undetectable" means that the virus was not fou

Biopsy examination and HPV testing?

Hello, doctor.
I had a Pap smear test at the beginning of November, and the result code was (4).
The following week, I returned for a biopsy and HPV (Human Papillomavirus) high-risk and low-risk type testing.
The biopsy result was CIN1 LSIL with code (6), but the HPV test result was Undetectable, indicating no viral load.
I would like to ask:
1.
Is it correct that an Undetectable HPV test result means negative? Does it indicate that there is no infection with any high-risk or low-risk types of HPV?
2.
If the answer to question 1 is correct, why is the HPV test result negative while the biopsy result shows CIN1?
3.
What is the likelihood of CIN1 completely resolving on its own due to the body's immune response?
4.
If the condition continues to worsen, besides the risk of developing cervical cancer, will it affect fertility?
Thank you for your response.

66, 20~29 year old female. Ask Date: 2020/11/24

Dr. Chen Zhiyu reply Obstetrics and Gynecology

Regarding your concerns, here are the responses in order:
Q1.
Is an undetectable HPV test result considered negative? Does it mean there is no infection with any high-risk or low-risk human papillomavirus?
A1.
The term "undetectable" means that the virus was not found in the testing environment at that time.
This could be due to the viral load being below the detection threshold of the testing equipment or the absence of the virus altogether.
Q2.
If the above is correct, why is the HPV test negative while the biopsy results show CIN1?
A2.
Although cervical lesions are highly correlated with the virus, the absence of the virus does not mean that cellular abnormalities cannot occur.
There are various external factors that can lead to tissue changes, such as genetic factors.
It is important to note that if a high-risk virus tests positive, there should be increased caution regarding the risk of future lesions.
Q3.
Is the chance of complete recovery from CIN1 through the body's immune response high?
A3.
According to current literature, if CIN1 is left untreated, there is about a 50% chance of spontaneous regression.
However, conversely, there is also a 50% chance that it may progress to CIN2 or higher.
Whether to pursue aggressive treatment should be discussed with your obstetrician-gynecologist and depends on your tolerance for risk management.
Q4.
If it continues to worsen, in addition to progressing to cervical cancer, will it affect fertility?
A4.
Once it has progressed to a cancerous state, concerns about fertility may become irrelevant.
It is advisable to address precancerous conditions that can be treated early to avoid potential regrets regarding fertility.
Thank you for your questions, and I wish you health and happiness.

Reply Date: 2020/11/24

More Info

Understanding the relationship between Pap smear results, HPV testing, and cervical intraepithelial neoplasia (CIN) is crucial for women's health. Your situation raises several important questions regarding these tests and their implications. Let's address each of your queries systematically.

1. HPV Testing Results: When your HPV test result is reported as "Undetectable," it generally indicates that no high-risk HPV types were found in your sample. This can mean that either there is no HPV infection present or the viral load is below the detection threshold of the test. Therefore, you can interpret this result as negative for high-risk HPV types, which are known to be associated with cervical cancer.

2. CIN1 with Negative HPV Test: The presence of CIN1 (cervical intraepithelial neoplasia grade 1) despite a negative HPV test can be perplexing. CIN1 is considered a low-grade lesion, and while HPV is a significant risk factor for cervical changes, it is not the only factor. Other factors, such as hormonal changes, inflammation, or even genetic predispositions, can lead to cellular changes in the cervix. It is also important to note that HPV infections can be transient; the virus may have been present at some point but cleared by your immune system before the HPV test was conducted.

3. Likelihood of Spontaneous Regression of CIN1: Research indicates that CIN1 has a relatively high rate of spontaneous regression. Studies suggest that approximately 50% of CIN1 lesions may resolve on their own within a few years, particularly in younger women. This is largely due to the body's immune response, which can effectively eliminate the abnormal cells. However, regular monitoring through Pap smears and follow-up examinations is essential to ensure that any changes in the cervical cells are detected early.

4. Impact of Progression on Fertility: If CIN1 were to progress to higher grades (CIN2 or CIN3), there could be implications for fertility, particularly if treatment is required. Treatments for higher-grade lesions may involve procedures such as LEEP (loop electrosurgical excision procedure) or conization, which can affect the cervix's structure. However, most women with CIN1 do not experience significant fertility issues, and the risk of progression to cervical cancer is low with proper monitoring. It is crucial to address any concerns with your healthcare provider, who can guide you based on your specific situation.

In summary, your HPV test being undetectable is a positive sign, indicating no current high-risk HPV infection. The presence of CIN1 does not necessarily imply a severe risk, especially given the potential for regression. Regular follow-up with your healthcare provider is essential to monitor any changes and to discuss any concerns regarding fertility or treatment options. Maintaining open communication with your healthcare provider will help you navigate these results and make informed decisions about your health.

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