Confused about HPV screening

All Woman

Dear Dr Mitchell,

Is it possible to have a normal result for my Pap smear and HPV screening when I have genital warts? I had warts a few months back so I went to see a gynaecologist. We did a Pap smear and HPV test which both came out normal. She prescribed Aldara cream for my warts which disappeared in a few weeks, and I also got a HPV vaccination, but three months after that the warts came back.

How is it possible to have warts with no HPV, if warts are caused by HPV? I am really confused.

Genital warts are sexually transmitted and are caused by the Human Papilloma Virus (HPV). Approximately 90 per cent of genital warts are caused by the subtypes of HPV 6 and 11. These are considered low risk HPV types and are not usually associated with a progression to vulval or cervical cancer. These subtypes are not the ones that are usually screened for in the usual tests that are done for HPV. The high-risk subtypes that cause cancer are the ones that the lab will normally check for. These are HPV subtypes 16, 18, 31, 33, 45, 52 and 58.

The high-risk subtypes cause cancer of the cervix, vulva, vagina, anus and throat. It is possible to contract several subtypes at the same time. Once you have vulval warts you are at risk for contracting high-risk HPV infection and so it is important to have regular Pap smears. However, it is possible for you to have warts on the vulva and not have HPV on the cervix. This would mean that you have the subtypes 6 and 11 and not the high-risk HPV subtypes. You should, however, repeat the Pap smear six months later to ensure that there is still no evidence of the HPV infection on the cervix since you are still at risk.

Aldara is a good choice to treat vulval warts since it helps to get rid of the warts and also clear the cervical tissue of the HPV. It is highly possible that the warts can recur since you can have the HPV in tissues that look normal and you get recurrence from these areas. The Aldara cream is usually applied directly to the area with the warts. It is important that your spouse is referred to his doctor to get a complete examination to see if he has any visible warts and he can also benefit from getting the HPV vaccine. This will reduce his chances of cancer of the penis, throat and anus.

The fact that your doctor gave you the HPV vaccine is a very good thing since this will reduce your risk of getting the HPV and cervical cancer from re-exposure to the virus during sexual contact.

Once you have a good immune system you will normally clear your system of already existing HPV infection with time. Young people usually have good immune systems and clear the HPV infection within several months. Older women over 30 years tend to have persistent infections with less ability to completely clear the HPV infection. Close follow-up with regular Pap smears, initially every six months for two years, may be necessary to pick up changes in the cervix that can lead to cancer of the cervix. Colposcopy can then be done to localise these abnormal cells and remove the area to reduce your risk of cancer of the cervix.

It is important for you to get the three doses of your HPV vaccine to ensure that you are fully vaccinated. Follow your doctor's advice and continue your regular screening and Pap smears and you will do well. It is also important for you to do a screening test for other major sexually transmitted infections such as syphilis, HIV, gonorrhoea and chlamydia. Your partner should also be tested.

Best regards.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Avenue, Kingston 5; or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.

DISCLAIMER:

The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.

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