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Re: HPVFrom: MaryG (anonymous@obgyn.net)Sun, 29 Jun 1997 14:13:41 -0500 (CDT)
At Sat, 28 Jun 1997, D. Ashley Hill, M.D. wrote: > >At Fri, 27 Jun 1997, MaryG wrote: >>She was told she needed a panhysterectomy >>with a BSO because an ultra sound showed areas suspicious >of small fibroids in uterine wall, a "history of HPV", and >class three Pap one time a year prior to the pregnancy.. >>I'd like to know if there is a more difinitive dx for HPV >and does it always have to wind up a hysterectomy? > >Mary- > >This is a tough question without a lot of other information, but I'll >take a stab at it. I'm unfamiliar with the term "panhysterectomy" but >will assume it means the same thing as "total abdominal hysterectomy" >which is removal of the uterus and cervix. None of the conditions you >mention need result in hysterectomy, although large and symptomatic >fibroids may often require this if other, more conservative, measures >fail. For example, my partner and I did a hysterectomy recently on a >woman with fibroids that continued to enlarge (to her umbilicus, or >roughly the size of a 5-month pregnancy) despite non-surgical therapy. >She was finished with childbearing, and was miserable. On the other >hand, there are many other methods to treat fibroids that may work and >we try these before resorting to a hysterectomy. I would not suggest >even treating "small fibroids in the uterine wall" unless she was having >symptoms or having difficulty conceiving! They are a benign condition >found in about 1/2 of black women and 1/3 of white women, that do not >require treatment unless symptomatic or enlarged enough to compress >surrounding organs. > >HPV is certainly the most common cause of atypical Pap smears, but not >the only one. HPV is an epidemic condition usually transmitted by >sexual relations (although I have seen rare cases possibly transmitted >by sharing underwear and swim suits). The overwhelming majority of >women with HPV (some say up to 1/2 of all US women!) never develop an >abnormal Pap, or genital warts. Like most viruses, it can remain >dormant for many years before popping up to cause trouble, so we ask >patients to have annual Pap smears. HPV is almost never a cause for >hysterectomy, unless severe atypia keeps recurring despite less >aggressive therapy (cryotherapy, burning, laser, or cold knife >conization). Again, there are always exceptions, but in my opinion a >doctor should try many other techniques before resorting to a >hysterectomy for the sole problem of an abnormal Pap (of course, cancer >is excluded from this, since it usually requires hysterectomy or >radiation). HPV can be diagnosed by cervical (or vulvar) biopsy, or by >taking a swab for viral typing. Your local lab can give you directions >on this. Again, HPV is extremely common, but as long as the Pap smears >are normal and there are no external warts, treatment is usually not >necessary. > >I hope this helps answer your questions. I advise patients (even my >own) that they may feel more comfortable with a second opinion before >undergoing a major surgery. A good doctor will not begrudge a second >opinion. > >Best of luck, > >Ashley > >-- >Ashley Hill >D. Ashley Hill, M.D. >Associate Director >Department of Obstetrics and Gynecology >Florida Hospital Family Practice Residency >Orlando, FL >dahmd@gate.net >
-- I'm gonna beat this one to death...is HPV the only condition that a biopsy would warrant a path report of "chronic cervicitis with squamous metaplasia exhibiting condylomatous atypia. Although no histologic dysplasia is identified in these biopsies, the extensive condylomatous change is probably sufficient to explain a previous class3 pap smear"? In the following 5 yrs all other paps were WNL although 3 colpos, one the same time as the above biopsy that showed 'punctation'(???), one 6 mos later that showed 'mosaic' and 'punctation'(???, and one 2 years after that showing 'mosaic, abnormal transformation zone and bulk effect'(????). On and off BCPs but off a year prior to the hysterectomy. Could it be anything else or could it only be HPV? There are no genital warts. This whole thing is driving me buggy. As always, thank you Sincerely Mary G
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