A woman had HPV-caused cervical cancer removed via loop electrosurgical excision procedure (LEEP) two years ago. All subsequent Pap smears and HPV tests have been negative. What is the likelihood of HPV returning?
Is it safe to assume that the virus will not return if the woman and her male partner are monogamous? Is there a chance that the man still has HPV even if he does not have any signs or symptoms?— Kandace McCarver, PA-C, Tucker, Ga.
A LEEP is primarily a treatment for women diagnosed with cervical intraepithelial neoplasia (CIN)—most often CIN 2/3—or premalignant cervical disease. Although invasive cancer can be diagnosed from the specimen obtained from a LEEP, unless this patient had a radical hysterectomy, radiation, or chemotherapy, I suspect she had CIN rather than invasive cervical cancer.
The prognosis for the patient described is good (she has only a 1.8% chance of recurrence). However, she cannot be 100% sure that she has completely cleared the virus. Furthermore, compared with the general population, this woman still has an increased risk of being diagnosed with invasive cervical cancer (56 per 100,000 vs. 5.6 per 100,000).
HPV infections can persist and recur. Even women in long-term monogamous relationships can get reinfected. In a randomized clinical trial, HPV-associated lesions regressed at higher rates when male partners of women with such lesions used condoms (Int J Cancer. 2003;107:811-816). Men are not routinely checked for HPV, but it is known that 75% to 80% of sexually active women and men carry, and thus are capable of transmitting, the virus, despite not having any signs or symptoms. Because HPV can be transient, a negative test is not a guarantee of total clearance of the virus.
The recommendation for this patient would be a semiannual Pap smear with HPV testing for two years following her LEEP. If all tests are negative, she can increase the interval to every three years until age 65 years. Although condom use would likely decrease the chance of the virus being passed back and forth between her and her partner, many HPV infections are attributed to reactivation of previously acquired infections, which a condom would not be able to prevent. — Mary Newberry, CNM, MSN (180-3)
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