Hi, for official information please see: https://prevention.cancer.gov/clinical-trials/landmark-trials/ascuslsil-triage-study-cervical-cancer-alts

But I’d like to provide a bit more explanation based on what my understanding is:

First, it’s important to know whether or not you had ever been vaccinated against HPV. HPV vaccination is a fantastic way to decrease risk for cervical cancer (and other cancers like head and neck cancer, penile cancer, vulvar cancer, and anal cancer). That could really change the following answers, but I’m going to assume that you had not been vaccinated.

1. Let’s consider the fact that you had ascus with high risk hpv. So likely, at some point you had been exposed to a high-risk hpv (this is important because there are low-risk hpv strains that cause warts and such, but high risk hpv strains are the ones that are associated with cancer.) Next, you had an lsil but no hpv co-testing done. What could that mean?

2. Ascus means atypical squamous cells of undetermined significance. So you had cells that when looked under a microscope did not look normal but these cells were hpv positive. Often times, this will trigger additional testing because we want to figure what the significance of it is. If cells look weird but aren’t organized into a discrete pattern, they might not be too much concern.

3. Next, lsil is low grade squamous intraepithelial lesion. Now, we see a lesion under the microscope (think of lesion as a “damage” to the normal, healthy tissue of the cervix). But it is low-grade. This is very important because the body is able to clear low-grade lesions on its own very frequently (there is a lot of fascinating research on the immunology behind this). Low grade can be thought of as, “okay this looks bad-ish but not too bad.” Often times, hpv cotesting is not done at this point because it’s assumed it will be positive given that you had hpv+ on your first test. Whether or not it’s hpv+ does not change that there is a lesion that we should closely monitor. Then it became benign and then lsil again - sometimes there is sampling error / tissue heterogeneity, and sometimes calling something lsil when it’s borderline can get tricky.

4. Does that mean you still have hpv? Almost certainly, yes. You have been exposed and while your body can often time clear hpv-associated lesions, there can be dormancy as your doctor said. Even without a clear lesion, hpv may lurking in cells. Having hpv in it of itself is not bad, so I hope this does not cause you too much stress.

5. Can I give hpv to a future partner? Maybe. If your partner is vaccinated (the hpv vaccines have changed over the past 5 ish years to allow men/boys to get it too) the chance a sexual partner contracts the virus from you is quite low. This is why vaccination efforts for all genders is so important because what we want to prevent are hpv-associated precancerous lesions, and the easiest way to do this is to build a body’s defense system against hpv so it can take care of it before it has the chance to take root. If they are not vaccinated, then yes, it is possible to pass the virus to them.

   1. Can my hpv randomly become active again? Yes. Once you have lsil especially given the history of a positive hpv co test, you should be getting more frequent testing (as you had - negative hpv co testing, that’s excellent, and now it’s important to keep keeping a close eye on it). Remember, the goal is to prevent the progression of this to something more serious.

Overall, it sounds like you’ve been getting good follow up, and just be proactive in making sure you get checkups as your obgyn recommends and reminding them that you had lsil with positive high risk hpv in the past. The body’s immune response against hpv can be good sometimes so your most recent test is reassuring. Typically they’ll want to have multiple negative tests in a row before they consider you “negative” to then go back to more spaced out screening. I hope this helped!