Four years ago, I learned I had gotten HPV through my husband. I was pregnant, so my doctor was unable to treat this condition. It seemed to go away on its own, and I went four years without any other complications. Last month I had an abnormal Pap and was diagnosed with Stage 3 cervical cancer in situ. I had LEEP surgery and was told it would be unlikely for me to carry a baby but it may be possible if I got stitches on my cervix. My question is, by having unprotected sex with my husband, am I constantly reinfecting myself with this virus? Or would a breakout naturally occur anyway? I can't really seem to get a clear answer to this question. I am 25 and would like have another child, but I don't want to risk becoming reinfected and needing a hysterectomy.

D.D.

Cancer of the cervix (the entrance to the uterus) is a common malignancy in women, despite the fact that it is nearly always preventable with routine screening with the Pap test. The Pap test identifies changes in the cervix that occur before the development of invasive cancer. Treatment varies, depending on the severity of these changes. In high-grade lesions, such as grade 3, experts recommend removing the cervical tissue containing the abnormal cells, and the loop electrosurgical excision procedure (LEEP) is one method for doing this.

LEEP involves using a special device -- a wire loop with a low level of electricity running through it -- to remove the affected cervical tissue. One of the procedure's risks is the possibility that in a future pregnancy, the cervix will not be able to contain the baby, and premature delivery or stillbirth will occur. This is by no means a certainty and doctors do not regard having had the procedure a reason to discourage future attempts to have children.

Most cases of cervical cancer are caused by infection with the human papillomavirus (HPV). Various serotypes (strains) of HPV are responsible for most warts, both genital and non-genital. The HPV serotypes that cause genital warts (one of the most common sexually transmitted diseases) can lead to mild changes on the Pap test, but usually do not result in the serious Pap test abnormalities associated with high-grade cervical changes or cervical cancer. Therefore, I would not be surprised if neither you nor your husband have ever had genital warts.

Treating HPV infections really only deals with the symptoms, not with the virus itself. One can cut out warts, freeze them with liquid nitrogen or destroy them with chemicals, but the virus remains in the body. Whether removing all genital warts will prevent transmission is unknown -- it probably does not. Similarly, LEEP had no effect on your infection with HPV, and this has two important consequences. First, you must continue to have regular screening to ensure that you have no recurrence of cervical abnormalities. Second, you cannot "catch" HPV again because you will likely always be infected with the virus. Thus, further unprotected sex with your husband is not likely to make a difference. One caveat, however, is that someone who has one sexually transmitted disease is more likely to have another, so you both should be tested for other infections, such as HIV and syphilis.