HPV Testing Explained: Who Needs It and How It’s Done
Key takeaways:
Human papillomavirus (HPV) is a virus that infects tissues of the genital areas, mouth, and skin.
Most HPV infections are cleared by the immune system, but sometimes the virus causes warts or even cancer.
Because HPV is the main cause of cervical cancer, HPV testing is recommended for people with a cervix who are ages 30 to 65.
You may have never heard of human papillomavirus (HPV) before, but it’s very likely that your immune system has encountered the virus. Almost all sexually active people come into contact with a strain of the virus — even if they only have one partner in their lifetime.
HPV can lead to a few different types of cancer, including cervical cancer. Getting tested for HPV, which is often done along with a pap smear, can help you know if you’re at risk for cervical cancer. That way, you can be monitored and treated before cells turn into cancer.
What is HPV?
Human papillomavirus is actually a family of viruses with more than 180 strains. It is spread in humans by skin-to-skin or sexual contact.
HPV infects skin, oral, or genital tissue. An infection can be aggressive and long term, or harmless and transient. It depends on the strain of HPV and the person’s immune system.
Generally speaking, there are three possible outcomes from an HPV infection:
It clears without causing any health problems.
It causes warts or skin lesions.
Infected cells become precancerous or cancerous.
A few aggressive strains of HPV are responsible for most cases of cervical cancer. Cells in the cervix (the opening of the uterus) are particularly susceptible to becoming cancerous because of an HPV infection. But HPV is also associated with other cancers in the mouth, throat, penis, anus, vulva, and vagina.
Most people do not have symptoms when they are infected with HPV, but some do. Symptoms of HPV infections of the cervix and female genital area might include:
Bleeding between periods
Pelvic pain
Bleeding during/after intercourse
A lesion or mass on the cervix
Genital warts
Because most people are asymptomatic, testing is the only reliable way to know if you have HPV — and if you are at increased risk for HPV-associated cancer.
Who needs to be tested for HPV?
People with a cervix who are between the ages of 30 and 65 should be tested for HPV. HPV infections are common in people younger than 30, but the immune system is good at clearing the infection at this stage of life.
HPV testing may be recommended for some people outside of the standard age group. This may be true for people who have:
A history of abnormal pap smears or positive HPV test
New sexual partners
Symptoms like genital masses, pain, or bleeding
A condition that dampens the immune system, like HIV
Medication that impairs the immune system
How is testing done for HPV?
The most common way to test for HPV is with a pap smear. During a pap smear, a swab is used to collect cells from the opening of the cervix. The cells are then tested for signs of cancer and for HPV.
Self-collected tests for HPV that use vaginal swabs or urine samples are being developed and studied. Though none are FDA approved yet, a less invasive way to check for HPV is on the horizon.
Do all pap smears include an HPV test?
Not all pap smears include HPV testing. Pap smears are designed to detect precancerous or cancerous cells in the cervix. But now that scientists know that HPV is the main cause of cervical cancer, it helps to know if high-risk HPV strains are present. It is one more piece of information that can help you know about your risk of developing cervical cancer.
For this reason, healthcare providers often do both a pap smear and HPV testing together. In fact, current guidelines say that testing just for HPV — without the pap cells— is enough for screening in certain age groups.
According to expert guidance for cervical cancer screening, women 30 to 65 years old should have one of the following:
HPV testing every 5 years
Pap smear every 3 years
Pap and HPV testing every 5 years (often called co-testing)
For people ages 21 to 29, pap smears without HPV testing are recommended every 3 years. Studies showed that testing for HPV in this age group led to unnecessary biopsies and surgical procedures. That’s because people who are 21 to 29 years old are more likely to clear HPV infections on their own.
What does it mean if you test positive for HPV?
A positive HPV test means different things for different people. It depends on the following factors:
If the HPV strain is a high-risk one, known to cause cancer
If there are abnormal cells on the pap smear
Whether or not this is the first time testing positive
The person’s age
If the person is immunocompromised
If the person takes medication that reduces immune system function
Based on these factors, if you are at higher risk for the HPV causing cancer, the next step after testing positive for the virus is usually a colposcopy. In this procedure, tiny biopsies are taken from the cervix and analyzed for signs of cancer. If you are not at a higher risk for cancer, your provider may recommend repeating the pap smear at a later time to see if the infection has cleared.
Can you have a false positive?
HPV tests are pretty accurate. Of course, a false positive can happen, just like with any screening test. But a positive HPV test should be taken seriously, especially if it is accompanied by:
Abnormal cells on the pap smear
Genotype testing showing the HPV is a high-risk type (e.g. 16, 18, 45)
What do I tell my partner if my HPV test is positive?
HPV is the most common sexually transmitted infection (STI). So, if you test positive for HPV, it is important to have a conversation with your sexual partner(s). Here are some topics to discuss during that conversation:
It is smart for both partners to get tested for gonorrhea, chlamydia, and other STIs, because 15% to 20% of people who test positive for HPV also have another STI.
Using condoms or other barrier protection during sex (including oral sex) can reduce the risk of transmitting HPV.
Even though male partners are often not affected by HPV, it can cause penis and other cancers. For example, male partners can be at risk for throat cancer if they perform oral sex. And males can transmit HPV to other/future partners.
Vaccination against HPV is standard and recommended for people of all genders, ideally before they become sexually active. And HPV vaccines are approved for people up to age 45 to help prevent HPV infections and cancers.
The bottom line
Human papillomavirus (HPV) is the main cause of cervical cancer, and most people are exposed to it at some point through sexual contact. So HPV testing — along with pap smears — is an important part of preventing cervical cancer.
HPV testing, which is recommended for people ages 30 to 65, can help catch problems early and keep you healthy. And remember that getting vaccinated against HPV is the best way to prevent an infection and its complications.
Why trust our experts?
References
Chesson, H. W., et al. (2014). The estimated lifetime probability of acquiring human papillomavirus in the United States. Sexually Transmitted Diseases.
Dunne, E. F., et al. (2013). HPV and HPV-associated diseases. Infectious Disease Clinics of North America.
Fowler, J. R., et al. (2022). Cervical cancer. StatPearls.
Luria, L., et al. (2022). Human papillomavirus. StatPearls.
Tatara, T., et al. (2022). The influence of vaginal HPV self-sampling on the efficacy of populational screening for cervical cancer—An umbrella review.Cancers.
U.S. Preventive Services Task Force. (2018). Cervical cancer: screening.
