Negative HPV after positive but inadequate sample for cell changes

Hi - first time posting so hoping for any information anyone might have as I am confused by my smear results.

I had a positive HR HPV result in Jan - but sample was inadequate to check for cell changes. So an anxious 3 month wait to be re-tested. I had another smear in April. Despite getting a letter for my 3 month recall in April the lab said they would not process it as it was 10 days too early. So another 3 month wait. I have just recieved my results and thankfully HPV negative but because it’s negative they didn’t check for cell changes. Is it possible to have cell changes and test negative for HPV - taking into account it was positive just 6 months ago?
All previous smears have been clear and I’ve been with my partner for 15 years so confused where the HPV has come from. It wasn’t detected in 2019 when I first had the new style HPV test. Is it possible that cell changes could be overlooked if only testing for HPV?

Any advice / experiences could be helpful.

Hi @Puzzled

Not any that would be of significance, as HPV is a necassary cause for precancer and progression into CC, the idea behind HPV primary testing (only checking for abnormalities when they detect the virus) is that without an active virus those cells cant exist and if they do exist from a recently deactivated infection, as the virus is no longer in an active state the cells can only regress

HPV has a terrible habit of laying dormant for many years, for some it can be decades before its detected, most infections are aquired within the first years of sexual activity and testing is only sensitive enough to pick up an infection when its active, it doesnt exclude one that may be dormant… all a negative result means is that the person doesnt have an active infection at the time of testing it doesnt mean they dont actually have HPV xx

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Thank you so much for replying and explaining. That makes sense. I wish the NHS would offer more information, the HPV testing is confusing. So without HPV being detected, there is no chance of abnormal cells? And presumably if I’ve tested positive previously and the virus is no longer active, it could re-activate again?
I have been advised I don’t need to re-test for 3 years, though given my history of a positive test that doesn’t seem prudent. Trying to assess how much I should worry about this.
Thanks again for replying, really appreciate it.

It would ease alot of anxiety if they did lol none that would be concerning, if your recently deactivated strain did cause cell changes, without the virus being active atm they cant progress further they can only revert back to normality

It may reactivate or your immune system can keep it under control, 10-20% can have reactivations down the line but 80-90% dont test positive for the same strain again… they use widespread studies to determine the best protocols aswell as considering the natural history of HPV infections (how it behaves) - reactivations essentially act like new infections… for cell changes to be a potential the virus needs to be in a continuous active state for more than 1-2 years, 89-90% of cases cell changes generally take years to progress through its grades but in 10-11% of cases CIN can progress quite quickly (i say quickly it still takes atleast 12 months - i went from borderline to CIN1 to CIN3 within my yearly follow up) however as they know how CIN behaves, its more CIN3 the direct precurser of CC that takes 3-15 years to become cancerous if its left to its own devices rather than starting from the 2 lower grades

As you are negative right now, if it were to reactivate anytime soon, taking into account the 1-2 years before cell changes are a potential (cell changes arnt guarenteed) then the 3-15 years of CIN3… the likelyhood of developing CC within the next atleast 4-5 years is extremely slim… so slim that they are starting to recommend all countries who use HPV testing to move all HPV negative smears to every 5 years insgead of 3 xx

Thanks so much for your reply and sharing your understanding. This is so useful, as understanding more helps to relieve the anxiety. Clearly your own experience has meant you’ve picked up a lot along the way and you explain it really well. I hope your treatment has progressed well.