HPV

The HPV test is primarily used to screen for cervical cancer and/or identify women who may be at increased risk of cervical cancer. The test determines whether a woman's cervical cells are infected with a high-risk type of human papillomavirus (hrHPV). Such an infection, if long-lasting, can cause changes in cervical cells that could lead to cervical cancer. Now that hrHPV infection is known to be the cause of most cases of cervical cancer, HPV testing has become an essential part of women's health screening.

Currently, the American College of Obstetricians and Gynecologists (ACOG), the U.S. Preventive Services Task Force (USPSTF), and the American Cancer Society (ACS) recommend the following options for routine cervical cancer screening in average-risk women aged 30 to 65 years:

• Co-testing with a Pap test and high-risk HPV test every 5 years (preferred), or
• Pap tests every 3 years (acceptable)

Significant changes to these recommendations may be on the horizon, however. The U.S. Food and Drug Administration (FDA) approved a high-risk HPV test as a primary screening tool for cervical cancer, meaning it may be used without a Pap test. Individual health organizations have yet to update their screening recommendations, but an expert panel issued interim (temporary) guidelines in 2015. (Read Experts Offer Advice on hrHPV Testing as a Primary Screen for Cervical Cancer.) Among the recommendations:

• The HPV test may be offered to women aged 25 to 65 without a Pap test.
• If initial results are negative, women should be screened again no sooner than 3 years.

More information about the use of the hrHPV test as the primary means of screening for cervical cancer will be forthcoming as the risks and benefits are further evaluated.

Because HPV infections are relatively common in women younger than 25 and often go away without treatment or complications, HPV screening is not recommended. However, HPV testing may be used as a follow-up test in women between the ages of 21 and 29 years who have abnormal results on a Pap test known as "atypical squamous cells of undetermined significance" (ASCUS) [see Pap Test Terminology]. Results may be used to determine the need for colposcopy, a procedure that allows a health practitioner to visually inspect the vagina and cervix under magnification for the presence of abnormal cells.

See Screening: Cervical Cancer (Adults), Cervical Cancer (Adults 50 and Up)

Several organizations currently recommend HPV testing along with a Pap test (co-testing) every 5 years as part of routine cervical cancer screening for average-risk women 30 to 65 years of age. Women aged 25 to 65 may choose the option of screening with an HPV test without a Pap test every 3 years.

More frequent screening is advised for women with risk factors such as exposure to DES (diethylstilbestrol) in utero, previous diagnosis of a high-grade precancerous cervical lesion or cervical cancer, HIV infection, or a compromised immune system.

HPV testing may be performed when a woman has abnormal changes on a Pap test.

HPV test results and Pap test results go hand-in-hand when determining a woman's risk for cervical cancer. Co-testing with an HPV test and Pap test, as recommended by current guidelines, can determine whether cervical cells are infected with a high-risk type of HPV and identify abnormal changes in cervical cells.

The following chart outlines the meaning of possible co-testing results and includes the American Cancer Society (ACS), American Society for Colposcopy and Cervical Pathology (ASCCP), and American Society for Clinical Pathology (ASCP) recommendations for follow up. Remember, co-testing is currently recommended for women aged 30 to 65 years.

If a Pap test is performed without an HPV test, the presence of abnormal cervical cells indicates the need to perform an HPV test to determine whether HPV infection is the cause of the cellular changes.

If an HPV test is performed without a Pap test, the 2015 interim guidelines suggested some follow-up steps that can be taken based on results of an initial hrHPV test. (They noted that these are based on limited data currently. Major studies are ongoing, however, and more data are expected soon.)

• After a negative result on an initial hrHPV test, a woman should not be re-screened for 3 years.
• A positive result for high-risk type HPV-16 or HPV-18 should be followed up with colposcopy.
• A positive result for the other 12 high-risk HPV types, such as HPV-31 and HPV-45, should be followed up with a Pap smear.
• A positive Pap smear would be followed up with colposcopy.
• A negative Pap smear would prompt follow-up testing in 12 months.

The most common HPV test detects DNA from several high-risk HPV types but cannot identify the specific subtype(s) that are present. Other tests are able to tell whether there is DNA or RNA from HPV types 16 and 18, the two types that cause 70% of cervical cancers.

Most people who become infected with high-risk types of HPV never develop precancerous changes or cancer.

Being infected with HPV does not necessarily mean that your partner is having sex outside your relationship. The HPV virus can hide in cervical cells for many years; so if either of you has ever had sex with another partner, you can pass the infection to your current partner.

Although very rare, a pregnant woman may pass HPV to her baby during vaginal delivery, resulting in warts in the throat or voice box (laryngeal papillomatosis or recurrent respiratory papillomatosis, RRP).

Being infected with HPV will not make it difficult for you to get pregnant or carry a pregnancy to term. However, some methods of treating precancerous growths resulting from HPV infection can make it more difficult to get pregnant or have an uncomplicated delivery.