Recurrence of same hpv type after 6 month mark

• By brieaukirsch
• Posted June 25, 2009 at 10:58 pm
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Ugh, here's one unfavorable study:
http://www.ncbi.nlm.nih.gov/pubmed/17614272

I don't know if their reasoning is any good because I am too tired to think about it right now but I jumped straight to the conclusion which is bad.

Can anyone shed light?

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• By corellin
• Posted June 26, 2009 at 11:59 am
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Hi -- I tried to find the full text of that article, but was unable (without paying), so I can't tell whether the researchers did type-specific testing or not. They're pulling their data from archival smears.

The main purpose of the test 6-12 months after treatment is to determine the likelihood that the treatment removed the existing dysplasia. If HPV is still positive after a procedure, then it's highly possible some dysplasia was missed.

Oftentimes, though, people will test positive for a new HPV strain -- even shortly after a procedure, such as a LEEP, and we know from the Gardasil vaccine, that even vaccination against 6, 11, 16 and 18 doesn't reduce the need for pap smears.

I think I read somewhere there was a 7% recurrence rate of the same HPV type several years after "clearance" after LEEP, but I can't find that article again. I'll do some more digging when I have time.

The conclusion of the above study was that a negative HPV test doesn't change the need for close followup monitoring, and I think we would all agree with that. I continue to have HPV tests, along with my paps, because I know that the HPV can re-activate (in a spot outside the excised area, if there is HPV in any cells outside the excised area) or I can get infected with a new or even the same type (which would not be a reactivation).

As long as a person continues to test negative for HPV, there's less a chance that they will develop dysplasia or have dysplasia that's just not being picked up by pap or colposcopy.

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• By brieaukirsch
• Posted June 26, 2009 at 6:57 pm
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Right, the abstract doesn't say whether it was a new infection or a recurrence of an old, but I assumed the latter because I'd think (hope) researchers would be smart enough to differentiate the two from the get-go. I definitely agree that close monitoring is necessary, but I saw a Swedish study (I think it was Swedish) that did the typical 6 weeks, 3 months, 6 months, 1 year, and 2 year testing, and said a "double-negative" (pap + hpv test) 6 month test obviated the need for the 1-year test, and the woman could return to regular annual screenings. Personally, I'm not comfortable with anything less than 6 month "double-screenings".

You bring up an interesting point about hpv becoming active in a non-excised area. I specifically asked my gyn to ablate the entire tz, or what he could see of it, after my cone-shaped ablation. I don't know if he did this, but since I kept developing new dysplastic areas, I wanted the entire tz treated. And doesn't even the most minimal of LEEPs remove the entire tz? I may be wrong since I didn't have LEEP but I thought that was the whole point.

And isn't hpv more frequently falsely-negative when a person's disease is more advanced than when it is lower-grade, because viral production and shedding drops off as the hpv becomes integrated into the host genome? (I shudder whenever writing or reading that.)

Thanks again for your thoughts, b

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• By corellin
• Posted June 27, 2009 at 10:23 pm
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Hi -- that may be true that viral shedding is less when cancer develops so more likely to get a false negative HPV test and I've wondered whether cervical stenosis or having less cervical mucus might also contribute to less fluid going down the cervical canal so HPV particles are less accessible. Thing is, we won't ever have certainty, which I know is very frustrating. About all we can do is keep up to date with the testing that's available, try to be as healthy as possibly (physically, mentally, emotionally) and enjoy our lives during this uncertain time. We might also check the "organ donor" box on our driver's license (just kidding)!

And, yes, I think LEEPs usually remove most, if not all, of the transformation zone, but I don't know for sure.

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• By brieaukirsch
• Posted June 28, 2009 at 1:35 am
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Oh, I didn't even think of the cervical mucus/glandular issue!

Ha, I hear you about the organ donor thing. This is getting tiresome. I don't know if I can ever rely on my results, and I don't even know what my anal results are because I got two different answers on the phone and no paper results despite repeated requests.

Here is a study similar to the one I paraphrased. It's not the same study but it came to the same conclusion about double negatives at 6 mo.

http://www.ncbi.nlm.nih.gov/pubmed/15199273?ordinalpos=1&itool=EntrezSystem 2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery _RA&linkpos=4&log$=relatedreviews&logdbfrom=pubmed

The study I paraphrased was a Scandinavian study as well.

Thanks, corellin!

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• By brieaukirsch
• Posted June 28, 2009 at 1:37 am
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...and in case anyone is interested, here is the study I paraphrased (bless the "related articles" function on pub med)

http://www.ncbi.nlm.nih.gov/pubmed/14529664?ordinalpos=1&itool=EntrezSystem 2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery _RA&linkpos=3&log$=relatedarticles&logdbfrom=pubmed

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• By corellin
• Posted June 28, 2009 at 2:34 am
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Thanks for sharing those studies. Based on that data, I think we should have some comfort knowing that a negative HPV test + normal pap 6 months following a procedure for CIN3 means very, very low likelihood of recurrence (at least in the near term) and low chance that any dysplasia was missed during the procedure.

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