Test Quick Guide

Human papillomavirus (HPV) is the most common sexually transmitted disease (STD) in the U.S. Almost all sexually active people who do not receive an HPV vaccine will become infected with HPV at some point in their life.

An HPV test uses a sample of cells to determine whether the cells are infected with a high-risk strain of HPV. Such an infection, if long-lasting, can cause changes in cervical cells that could lead to cervical cancer.

An HPV test primarily screens for the virus that causes cervical cancer but may also be used to plan treatment for patients diagnosed with oropharyngeal cancer, which affects the middle part of the throat.

About the Test

Purpose of the test

The purpose of an HPV test is to detect an infection with a high-risk strain of HPV. An HPV test may be performed in several situations:

  • Cervical cancer screening: Tests look for cancer/precancerous conditions before symptoms arise; early detection is easier to treat. Most cervical cancers are caused by HPV, and testing allows patients infected with high-risk HPVs to be monitored effectively and to have abnormal cervical cells removed before they are cancerous. Anyone with a cervix, including women and transgender men, can be screened.
  • Follow-up: An HPV test may be used as a follow-up test after an abnormal Pap smear.
  • Oropharyngeal cancer treatment planning: This type of cancer begins in the tonsils or back of the throat. HPV causes the majority of oropharyngeal cancers. HPV-positive oropharyngeal cancers may be treated differently than HPV-negative oropharyngeal cancers, so HPV testing is an important part of treatment planning.

HPV infections can cause several other types of cancer, including cancers of the anus, penis, vagina, and vulva. However, HPV testing on these parts of the body is uncommon in the U.S. and is typically only performed for research purposes.

What does the test measure?

An HPV test detects evidence of an infection with a high-risk strain of HPV. There are over 100 known strains of HPV, only some of which are spread through sexual contact. Sexually-transmitted HPV strains are separated into two categories:

  • Low-risk HPV: These strains of HPV are rarely linked with cancer. While most low-risk HPV infections cause no disease, some strains can cause warts on the genitals and anus or in the mouth and throat. Doctors can typically diagnose low-risk HPV based on a patient’s symptoms, so testing for these strains is not performed.
  • High-risk HPV: Researchers have identified around 14 strains of high-risk HPV that can cause cancer. HPV testing indicates whether you currently have or have been infected with a high-risk strain, but not every HPV test identifies the specific strain causing an infection. Determining the specific strain is called HPV genotyping.

HPV test measurements depend on the specific type of HPV test that was performed. Types of tests generally fall into three categories:

  • HPV DNA testing: A patient’s cells are examined in a laboratory for the genetic material (DNA) of HPV. If evidence of the disease is detected, HPV genotyping may be performed to determine the specific strain causing infection.
  • HPV ribonucleic acid (RNA) testing: A sample of cells is examined in a laboratory for a different type of genetic material called RNA. This test offers improved specificity compared to HPV DNA testing, reducing the number of false positives and unnecessary follow-up. HPV RNA testing may also include HPV genotyping.
  • Detection of cellular markers: Unlike other types of HPV testing, this method doesn’t look for the genetic material of the HPV virus. Instead, it looks for evidence of two proteins called p16 and Ki-67. The amount of these proteins is elevated in cell samples that are infected with the HPV virus.

When should I get an HPV test test?

How often you should get an HPV test depends on your age, health, and history of cervical cancer screening. This screening may involve a Pap smear, an HPV test, or co-testing with both at the same time.

Professional medical organizations offer cervical cancer screening recommendations. For example, the U.S. Preventive Services Task Force recommends that women undergo regular cervical cancer screening between ages 21 and 65:

  • Ages 21 to 29: Most people this age need screening for cervical cancer every three years with a Pap smear alone. Many experts don’t recommend testing in this age group because HPV is very common in young people, and most infections resolve without treatment, so a positive test may be misleading. It also takes many years for an HPV infection to cause cancer.
  • Ages 30 to 65: At this age, there are several options for cervical cancer screening. You can be screened every three years with a Pap smear alone, every five years with an HPV test alone, or every five years with both.

Talk to your doctor about the options. Each person’s situation is different. But if you have certain risk factors, your doctor will probably recommend screening for cervical cancer more often. That includes:

  • A history of abnormal Pap smears
  • HIV
  • A mother who was exposed to diethylstilbestrol (DES) while pregnant
  • A weakened immune system

Not everyone needs cervical cancer screening. Your doctor can provide recommendations, but generally, the screening is not necessary in these situations:

  • You are under 21 years of age
  • You are older than 65, have had adequate screening in the past, and are not at an increased risk of cervical cancer
  • You have had a hysterectomy and do not have a history of abnormal Pap smears or cervical cancer

If you have an abnormal Pap smear, your doctor might recommend an HPV test to determine if abnormal cell changes are related to an HPV infection and require additional follow-up.

On a different note, if you are diagnosed with oropharyngeal cancer, HPV testing may be conducted on a tissue sample after a diagnosis of cancer is confirmed.

Finding an HPV Test

How can I get an HPV test?

Usually, your doctor will order the HPV test and it is performed at a hospital, doctor’s office, or another clinical setting. Some community health programs also offer HPV testing through county health departments and other sites to make the screening accessible to all. You may choose to order an at-home HPV test kit that includes a swab and instructions so you can gather the sample and send it to a lab for analysis.

Can I take the test at home?

At-home HPV tests are a discreet option that allows you to detect high-risk HPV infections by using a swab for women or a urine sample for men. These at-home kits do not differentiate among high-risk types and results will show “detected” or “not detected.” Your sample is reviewed by a certified laboratory, and it is important to discuss the results with your doctor.

Keep in mind that an at-home HPV test is not a substitute for cervical cancer screening by a health care professional. But the at-home option is a great way to identify whether you have been exposed to a high-risk HPV strain so you can seek further evaluation and treatment.

You can also get an at-home 3-site HPV test that allows you to collect oral, anal, and genital samples. This test also detects high-risk HPV types and delivers a “detected” or “not detected” result. It will not show which type of HPV is present if you test positive. This test does not replace a regular cervical cancer screening by your doctor, so always discuss the results with a medical professional.

How much does the test cost?

The cost of an HPV test depends on the type of test, where it is taken, and if you have insurance. Testing costs can include a doctor’s office visit, lab fee, and laboratory analysis. At-home HPV test kits can cost from $99 to $219. Local and federal health departments may offer financial assistance for HPV tests if you are under- or uninsured, and some free clinics offer testing.

Taking an HPV test

An HPV test for cervical cancer screening and Pap smear follow-up includes collecting a sample of cells from the cervix with a swab or small brush. To identify high-risk types of HPV, at-home tests use a swab to collect cells from the vagina. Three-site HPV at-home tests collect cells from the vagina, anus, and mouth.

Before the test

For the most accurate HPV test results, there are some precautions to keep in mind so you can properly prepare for the screening.

  • Do not have an HPV test while menstruating
  • Avoid tampons for two days before an HPV test
  • Do not use vaginal medicines or birth control foams for two days before an HPV test
  • Do not douche within two days of an HPV test
  • Refrain from having sex two days before an HPV test

If you’re taking an at-home HPV test, read the instructions carefully and prepare the specimen collection container before you collect the sample. The instructions will indicate how to prepare for the specific test. Note that kits can vary.

During the test

There are a couple of different ways HPV tests are conducted. You can get an HPV test at your doctor’s office during a pelvic exam. In this case, your provider will examine the vulva, vagina, cervix, rectum, and pelvis while you are on an exam table, with your feet in stirrups.

The HPV test involves inserting a speculum (small instrument) into the vagina so your doctor can see the cervix and then obtain a cell sample with a small brush, spatula, or scraper. It takes a few seconds and should be painless.

If you’re getting a Pap smear at the same time, the sample will be used for both tests. Your doctor might obtain two samples, but this is not always necessary.

During the test, you might feel slight cramping or pressure, but the process is quick and should not hurt. You might be more comfortable if you urinate before the HPV test.

If you’re taking an HPV test at home, you’ll use a swab to collect cell samples from the cervix and vagina. Three-site tests involve swabbing the mouth, anus, and vagina/cervix. You’ll then place the swab in a specimen container and send it to the test kit’s lab. Be sure to read at-home HPV test instructions carefully before beginning the process, and always discuss results with your doctor.

After the test

After an HPV test, it’s business as usual. There are no restrictions and you can continue with your regular daily activities. You might experience some spotting or discharge for a short time after the test. This is nothing to be concerned about.

After taking an at-home HPV test, follow the kit instructions and mail the specimen to the lab. Usually, these test kits offer specific packaging for you to use for this purpose.

HPV Test Results

Receiving test results

You can receive at-home HPV test results within three to four days of the lab receiving your specimen. Account for shipping time. You may get results by phone, secure email, the testing company’s web portal, or a smartphone application. Doctors’ office HPV test results are usually available within a week. You might receive results on a secure online portal or receive a phone call from your doctor to discuss the results or make a follow-up appointment if necessary.

Interpreting test results

HPV test results are reported as positive or negative.

A positive test result indicates that evidence of an infection with a high-risk strain of HPV was found in the sample of cervical cells. If HPV genotyping was performed, results may include the individual strain of HPV detected. HPV genotyping usually looks for HPV 16 and 18, the strains associated with the highest risk of cancer, but sometimes also includes testing for other high-risk HPV types.

A negative HPV test result means that there is no evidence of an infection with a high-risk strain of HPV at the time of the test.

At-home test kit results can report results as “detected” or “not detected” but do not identify which high-risk strains are present if your test is positive.

Always consult with your doctor about HPV test results. If you get your test at a clinic, hospital, or medical setting, a health care professional will follow up with you to discuss the results and any follow-up steps, if necessary. If you take the test at home, discuss your results with your doctor. They might recommend further testing and can answer any questions about the test, results, and next steps.

Follow-up testing might be necessary if an HPV test is positive or you have an abnormal Pap smear. Your age and health history also come into play. For example, you might have a greater risk of developing abnormal cervical cells.

Depending on your estimated risk level, a positive HPV test may signal the need for shorter intervals between HPV tests in the future, a follow-up Pap smear, or the need for expedited treatment to remove abnormal cervical cells. Additional considerations after a positive HPV test include:

  • Detecting HPV 16 or 18: If HPV genotyping detects an infection with HPV 16 or 18, doctors may recommend a colposcopy to examine the cervix and a biopsy to look for abnormal cells that require treatment.
  • First positive result: If you have a positive HPV test after previous negative results, it usually means a new HPV infection. While most new HPV infections will be followed up by a negative result in six to 12 months, this doesn’t always mean that the body has cleared the infection. The HPV virus can go dormant and reappear on future tests.
  • Recurrent positive result: This is a positive HPV test, followed by a negative HPV test, and then another positive test result. Most recurrent positive infections are reactivations of dormant infections that were acquired soon after you became sexually active. Recurrent positive results increase the risk for a persistent HPV infection.
  • Persistent positive results: While most people clear the HPV virus within one to two years without complication, about 10% of patients with HPV on the cervix develop persistent infections or two consecutive positive HPV tests at least 12 months apart. If you have persistent HPV infections, you are at a higher risk of developing abnormal cell changes in the cervix, so work with a doctor for appropriate follow-up.

A doctor can address detailed questions about HPV and your test results. Some questions that you might wish to review with your doctor include:

  • What does my test result mean for my future cervical cancer screening?
  • Are there any follow-up tests that may be beneficial given my test result?
  • Am I a good candidate for HPV vaccination?

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