At a Glance
Why Get Tested?
Most often, to screen for infections in women with the types of HPV that are associated with cervical cancer or to follow up on an abnormal Pap smear; sometimes to detect an HPV infection in men as there is a potential correlation between HPV infection and anal or penile cancer
When to Get Tested?
If you are a woman age 30 or older; if you are a woman 21 years or older and have an abnormal Pap smear; if you are a man at high risk for HPV infection
In females, the test requires a sampling of cells from the cervical area. In males, the necessary sample involves anal swabs or brush specimens. Currently, there are no tests approved by the Food and Drug Administration (FDA) to detect HPV in males; however, some specialty labs have validated DNA tests for analyzing anal swabs from males.
Test Preparation Needed?
It is recommended that you do not douche or tub bathe before the test. Reschedule the test if you are menstruating. You may be asked to empty your bladder before the examination. Some doctors may request that you refrain from sex for 24 to 48 hours before the test.
The Test Sample
What is being tested?
Human papillomavirus (HPV) is a group of about 100 related viruses. Some types can cause skin warts while other types can cause genital warts (also called condylomata). Common in young women and men, most HPV infections that are spread through oral, anal or genital sex are short-lived and relatively benign. There are, however, several types of HPV (such as HPV-16, HPV-18, HPV-31, and HPV-45) that are considered high-risk. They do not usually cause visible warts, but persistent infections have been linked to cervical cancer as well as other less common cancers, such as of the vagina, mouth, throat, penis, and anus. The HPV DNA test detects the genetic material of the high-risk types of HPV associated with cancer. Some of the genetic tests detect the types that are low-risk and cause warts, but they are generally not recommended for that purpose.
Genital HPV is one of the most common sexually transmitted diseases in the world. According to the U.S. Centers for Disease Control and Prevention, 20 million people in this country are infected with HPV and over 6 million become newly infected each year. At least 50% of sexually active women and men contract HPV at some point in their lives. HPV that cause genital warts can be diagnosed through visual inspection and therefore do not require testing. High-risk types that have been associated with cancer can be diagnosed with an HPV DNA test.
Persistent infections with certain types of HPV are now known to be the major risk factor for cervical cancer. HPV types 16 and 18 account for about 70% of cervical cancers in the U.S. Each year, more than 12,000 women in the U.S. develop cervical cancer and about 4,200 die from it. In addition, some studies have also shown that persistent oral infections with high-risk types of HPV are strongly associated with oral cancers, including cancer of the mouth and throat. Anal cancer has also been linked to HPV types 16 and 18.
How is the sample collected for testing?
A sampling of cells is taken from the cervical area in females during a pelvic examination using a type of wooden "spatula," swab, or brush. If HPV DNA testing is to be performed, the sample is placed into a special liquid preservative. HPV tests may also be ordered on male patients; an anal swab or brush specimen is used for testing.
NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.
Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.
Is any test preparation needed to ensure the quality of the sample?
It is recommended that you do not douche or tub bathe before the test, and you should reschedule the test if you are menstruating. You may be asked to empty your bladder before the examination. Some doctors may request that you refrain from sex for 24 to 48 hours before the test.
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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.
Sources Used in Current Review
American Academny of Pediatrics. American Academy of Pediatrics Policy Statement. HPV Vaccine Recommendations. Available online at http://pediatrics.aappublications.org/content/129/3/602.full.pdf+html through http://pediatrics.aappublications.org. Published February 27, 2012. Accessed April 19, 2012.
Press release. FDA Approves New Indication for Gardasil to Prevent Genital Warts in Men and Boys. Available online at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm187003.htm through http://www.fda.gov. Issued October 16, 2009. Accessd March 23, 2009.
National Cancer Institute. Fact Sheet. HPV and Cancer. Available online at http://www.cancer.gov/cancertopics/factsheet/Risk/HPV through http://www.cancer.gov. Accessed March 23, 2012.
National Cancer Institute. Treatment Options by Stage. Available online at http://www.cancer.gov/cancertopics/pdq/treatment/cervical/Patient/page5 through http://www.cancer.gov. Accessed March 23, 2012 .
Centers for Disease Control and Prevention. Genital HPV Infection - Fact Sheet. Available online at http://www.cdc.gov/std/HPV/STDFact-HPV.htm through http://www.cdc.gov. Last updated February 15, 2012. Accessed april 19, 2012.
Eilleen F. Dunne et al. Prevalence of HPV Infection Among Females in the United States. JAMA. 2007;297(8):813-819. Available online at http://jama.ama-assn.org/content/297/8/813.full through http://jama.ama-assn.org. Accessed February 19, 2007.
Centers for Disease Control and Prevention. HPV and Men - Fact Sheet. Available online at http://www.cdc.gov/std/HPV/STDFact-HPV-and-men.htm through http://www.cdc.gov. Last updated February 23, 2012. Accessed April 23, 2012.
Centers for Disease Control and Prevention. Cervical Cancer Rates by Race and Ethnicity. Availabe online at http://www.cdc.gov/Features/dsCervicalCancer/ through http://www.cdc.gov. Updated January 26, 2011. Accessed April 23, 2012.
American College of Obstetricians and Gynecologists (ACOG). Cervical cytology screening. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2009 Dec. 12 (ACOG practice bulletin; no. 109). Available online at http://www.guideline.gov/content.aspx?id=15274#Section420 through http://www.guideline.gov. Accessed March 23, 2012
U.S. Preventive Services Task Force. Screening for Cervical Cancer. Release Date: March 2012. Available online at http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm. Accessed March 2012.
Moyer, VA on behalf of the U.S. Preventive Services Task Force. Screening for Cervical Cancer: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine, March 6, 2012, 156(5). Available online at http://www.annals.org/content/early/2012/03/14/0003-4819-156-12-201206190-00424.full through http://www.annals.org. Accessed March 2012.
American Cancer Society. New Screening Guidelines for Cervical Cancer. Article date: March 14, 2012. Available online at http://www.cancer.org/Cancer/news/News/new-screening-guidelines-for-cervical-cancer through http://www.cancer.org. Accessed March 2012.
Press release. FDA Approved First DNA Test for Two Types of Human Papillomavirus? Agency also approved second DNA test for wider range of HPV types. Food and Drug Administration. Available online through http://www.fda.gov. Issued March 13, 2009. Accessed April 23, 2012.
Cleveland Clinic. Understanding Cervical HPV. Available online at http://www.clevelandclinic.org/health/health-info/docs/3800/3808.asp?index=11901 through http://www.clevelandclinic.org. Last updated January 2012. Accessed April 23, 2012.
Centers for Disease Control and Prevention. Human Papilloma Virus (HPV): What is HPV. Available online at http://www.cdc.gov/hpv/WhatIsHPV.html .Last updated March 22, 2012 through http://www.cdc.gov. Accessed April 23, 2012.
Centers for Disease Control and Prevention. Making Sense of Your Pap & HPV Test Results. Available online at http://www.cdc.gov/std/hpv/pap/default.htm#sec5 through http://www.cdc.gov. Accessed April 2012.
(March 22, 2012) American Cancer Society. HPV and Cancer. Available online through http://www.cancer.org. Accessed June 2012.
(January18, 2012) American Cancer Society. Cervical Cancer, Key Statistics. Available online at http://www.cancer.org/Cancer/CervicalCancer/DetailedGuide/cervical-cancer-key-statistics through http://www.cancer.org. Accessed June 2012.
Reuters. Wait longer between Pap tests, doctors say. October 22, 2012. Available online at http://www.reuters.com/article/2012/10/22/health-cancer-papsmear-idUSL3E8LM84D20121022 through http://www.reuters.com. Accessed November 2012.
ACOG. Ob-Gyns Recommend Women Wait 3 to 5 Years Between Pap Tests. October 22, 2012. Available online at http://www.acog.org/About_ACOG/News_Room/News_Releases/2012/Ob-Gyns_Recommend_Women_Wait_3_to_5_Years_Between_Pap_Tests through http://www.acog.org. Accessed November 2012.
Sources Used in Previous Reviews
National Institute of Allergy and Infectious Diseases website. Available online at http://www.niaid.nih.gov/factsheets/stdhpv.htm through http://www.niaid.nih.gov.
Centers for Disease Control and Prevention website. Available online at http://cdc.gov/nchstp/dstd/Fact_Sheets/FactsHPV.htm through http://cdc.gov.
American Social Health Association website. Available online at http://www.ashastd.org/stdfaqs/syphilis.html through http://www.ashastd.org.
Interview with Nadine Bartholoma, MS, MT (ASCP), SM. Virology Coordinator at University Hospital Pathology Laboratory, SUNY Upstate Medical University in Syracuse, NY.
Thomas, Clayton L., Editor (1997). Taber’s Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].
Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby’s Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.
(2004 Copyright). Human Papilloma Virus (HPV). American Cancer Society [On-line information]. Available online through http://www.cancer.org.
Bren, L. (2004 January February). Cervical Cancer Screening. FDA Consumer Magazine [On-line article]. Available online at http://www.fda.gov/fdac/features/2004/104_cancer.html through http://www.fda.gov.
(2004 Copyright). Human Papillomavirus (HPV). ARUP's Guide to Clinical Laboratory Testing [On-line testing information]. Available online at http://www.arup-lab.com/guides/clt/tests/clt_302a.jsp#3465668 through http://www.arup-lab.com.
(2004 May 4). Revised Cervical Cancer Screening Guidelines Require Reeducation of Women and Physicians. ACOG [On-line news release]. Available online at http://www.acog.org/from_home/publications/press_releases/nr05-04-04-1.cfm through http://www.acog.org.
(2004 Copyright). The High-Risk HPV Test: A Breakthrough in Cervical Cancer Screening. The HPVtest.com [On-line information from Digene Corportaion]. Available online at http://www.thehpvtest.com/factsheet.html through http://www.thehpvtest.com.
American Cancer Society, ACS News Center, HPV Vaccine Approved; Prevents Cervical Cancer (article date June 8, 2006). Available online through http://www.cancer.org.
National Cancer Institute, Human Papillomas Vaccines: Questions and Answers (June 2006-online information). Available online at http://www.cancer.gov/cancertopics/factsheet/risk/HPV-vaccine through http://www.cancer.gov.
U.S. Food and Drug Administration fact sheet (June 2006-online information). Available online at http://www.fda.gov/womens/getthefacts/hpv.html through http://www.fda.gov.
Darragh TM, Winkler B. The ABCs of anal-rectal cytology. CAP Today. College of American Pathologists, May 2004 (Online information). Available online at http://www.cap.org/apps/docs/cap_today/pap_ngc/NGC_analrectalcyto.html through http://www.cap.org.
Palefsky JM, Holly EA, Ralston ML, Jay N. Prevalence and risk factors for human papillomavirus infection of the anal canal in human immunodeficiency virus (HIV)-positive and HIV-negative homosexual men. J Infect Dis 1998;177:361-7.
American Cancer Society (July 2006) Cancer reference information, Overview: anal cancer, How is cancer found? Available online through http://www.cancer.org.
Pagana, Kathleen D. & Pagana, Timothy J. (© 2007). Mosby's Diagnostic and Laboratory Test Reference 8th Edition: Mosby, Inc., Saint Louis, MO. Pp 546-548.
Centers for Disease Control and Prevention: Genital HPV Infection - CDC Fact Sheet. Available online at http://www.cdc.gov/std/HPV/STDFact-HPV.htm through http://www.cdc.gov. Accessed June 19, 2009.
Davis, A. J. 2009 May 28. Clinical usefulness of HPV DNA testing and genotyping. Journal Watch Women's Health.
FDA approved first DNA test for two types of human papillomavirus; agency also approved second DNA test for wider range of HPV types. 2009 Mar 13. US Food and Drug Administration. Available online at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm149544.htm through http://www.fda.gov. Accessed 9 Jun 2009.
FDA approves two DNA tests to detect HPV. 2009 Mar 17. Infectious Disease News. Available online at http://www.infectiousdiseasenews.com/article/37896.aspx through http://www.infectiousdiseasenews.com. Accessed 9 Jun 2009.
FDA approves two Hologic HPV tests (press release). 2009 Mar 13. Hologic, Inc. Available online at http://www.hologic.com/news-releases/view/173-year.2009_173-id.234881444.html through http://www.hologic.com. Accessed 9 Jun 2009.
Descriptions of new FDA-approved HPV DNA tests (clinical update). American Society for Colposcopy and Cervical Pathology. PDF available for download at http://www.asccp.org/pdfs/consensus/clinical_update_20090408.pdf through http://www.asccp.org. Accessed 11 Jun 2009.
Solomon D, Papillo J, Davey D, on behalf of the Cytopathology Education and Technology Consortium. Statement on HPV DNA Test Utilization. Am J Clin Pathol 2009;131:768-769.
Human papillomaviruses and cancer: questions and answers (fact sheet). National Cancer Institute. Available online at http://www.cancer.gov/cancertopics/factsheet/Risk/HPV through http://www.cancer.gov. Accessed 9 Jun 2009.