Human Papillomavirus (HPV) Test

Human papillomavirus (HPV) is the most common sexually transmitted disease (STD) in the United States. 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 is primarily used to screen for the virus that causes cervical cancer but may also be used to plan treatment for patients diagnosed with oropharyngeal cancer, a type of cancer that affects the middle part of the throat.

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: Cancer screening tests look for cancer or precancerous conditions before a person experiences symptoms in order to detect them early when they are easier to treat. Most cervical cancers are caused by HPV. HPV testing allows patients infected with high-risk HPVs to be monitored effectively and to have any abnormal cervical cells removed before they develop into cancer. Cervical cancer screening is appropriate for anyone with a cervix, including women and transgender men who have a cervix.
• Follow-up: An HPV test may be used as a follow-up test after an abnormal Pap smear.
• Oropharyngeal cancer treatment planning: Oropharyngeal cancer is a type of cancer that begins in the tonsils or back of the throat. The majority of oropharyngeal cancers are caused by HPV. 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 United States 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: Low-risk strains of HPV are rarely linked with cancer. While most low-risk HPV infections cause no disease, some strains of low-risk HPV 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. These strains can cause cancer. HPV testing indicates whether a person is currently or has been infected with a high-risk strain, but not every HPV test identifies the specific strain of HPV causing an infection. Determining the specific strain of HPV is called HPV genotyping.

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

• HPV DNA testing: In HPV DNA testing, a patient’s cells are examined in a laboratory for the genetic material (DNA) of HPV. If evidence of HPV is detected, HPV genotyping may be performed to determine the specific strain of HPV causing infection.
• HPV ribonucleic acid (RNA) testing: In HPV 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 amount 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, cellular marker detection doesn’t look for the genetic material of the HPV virus. Instead, this type of testing looks for evidence of two proteins called p16 and Ki-67. The amount of these proteins are elevated in cell samples that are infected with the HPV virus.

When should I get an HPV test?

When used as a test to screen for cervical cancer, how often a person should get an HPV test depends on their age, health, and their history of cervical cancer screening. Cervical cancer screening may involve a Pap smear, an HPV test, or co-testing with both tests at the same time.

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

• Ages 21 to 29: Most people with a cervix between 21 and 29 years old should get screened for cervical cancer every three years with a Pap smear alone. Many expert groups don’t recommend HPV testing in this age group because HPV is exceedingly common in young people, and most HPV 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: For people with a cervix between 30 and 65 years old, there are several options for cervical cancer screening. Patients in this age group may choose to be screened every three years with a Pap smear alone, every five years with an HPV test alone, or every five years with both a Pap smear and an HPV test.

Patients should have a discussion with their health care provider about the pros and cons of different screening strategies in order to decide which approach is best for their situation.

Patients may need to be screened for cervical cancer more often if they have one of the following risk factors:

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

Other groups do not need regular cervical cancer screening. These include:

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

An HPV test may also be recommended as a follow-up test for patients who have had an abnormal Pap smear to help doctors understand if abnormal cell changes are related to an HPV infection and require additional follow-up.

In patients diagnosed with oropharyngeal cancer, HPV testing may be conducted on a tissue sample after a diagnosis of cancer is confirmed.

How to get tested

An HPV test is typically ordered by a doctor. HPV testing is performed at hospitals and doctor’s offices, as well as clinics and community health programs. The analysis of cell samples is performed in a medical laboratory.

Can I take the test at home?

At-home HPV tests are available to detect high-risk HPV infections. At-home HPV testing allows users to collect samples that include both cervical and vaginal cells at home and mail them to a certified laboratory for testing.

If an at-home test comes back positive or if a patient has questions about cervical cancer screening, it’s important to contact a doctor. An at-home HPV test is not a substitute for regular cervical cancer screening overseen by a health care professional.

How much does the test cost?

The cost of an HPV test depends on where the test is taken and if the patient has insurance coverage. Costs of testing may include the office visit, the fee for the health care professional to conduct the HPV test, and the actual laboratory analysis.

Most health insurance plans cover HPV tests without requiring a copay or deductible. Local and federal health departments may offer financial assistance programs for HPV tests for people who don’t have insurance.

The cost of at-home HPV testing ranges from $50 to $90.

For cervical cancer screening and Pap smear follow-up, an HPV test requires a sample of cells from the opening of the cervix. These cells are obtained by gently scraping the cervix with a swab or small brush. At-home HPV testing provides a swab to collect a sample of cells from the vagina.

In patients diagnosed with oropharyngeal cancer, an HPV test is conducted on a sample of the tumor tissue and requires no additional medical procedures for the patient.

Before the test

Before taking an HPV test to screen for cervical cancer, it’s important for patients to keep several precautions in mind:

• 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
• Refain from having sex two days before an HPV test

For people taking an at-home HPV test, it’s important to begin by reading all of the instructions contained in the testing kit and preparing the specimen collection container prior to collecting the sample.

During the test

An HPV test may be conducted during a pelvic examination. A pelvic examination involves lying on an exam table with the patient’s feet in stirrups while a health care provider examines the vulva, vagina, cervix, rectum, and pelvis.

During the HPV test, an instrument called a speculum is gently inserted into the patient’s vagina, allowing the health care provider to see the cervix. Once the provider can see the cervix, they obtain a small sample of cells by gently scraping the cervix with a brush, spatula, or scraper. This portion of the HPV test only takes a few seconds.

If a patient is also having a Pap smear as part of cervical cancer cotesting, the same sample may be used for both the HPV and Pap tests or, in some cases, a provider will obtain two samples.

Most patients experience little to no pain or discomfort during the collection of samples for an HPV test. Some may experience a feeling of pressure or temporary cramping similar to menstrual cramps. Patients may feel more comfortable if they urinate before an HPV test.

During an at-home HPV test, a swab is used to collect a sample of cells from the cervix and vagina. After collecting the sample, the swab is placed into a specimen container from the testing kit.

After the test

While patients may experience vaginal bleeding or discharge for a short time after an HPV test, there are no restrictions on activities after an HPV test is complete.

After an at-home HPV test is completed, the specimen container is packaged and sent to a laboratory for analysis.

Receiving test results

Results of HPV testing may be available within one to three weeks after completing the test. The results may be reported during a follow-up appointment with your doctor, over the phone, by mail, or through online medical charts.

It’s important to discuss HPV test results with a doctor, as a doctor can help you manage your risk for HPV and other STDs, answer questions about test results, and create a plan for cervical cancer screening.

At-home HPV test results may take additional time, as the samples must be sent to a laboratory by mail before testing can begin. Once the test is completed, results may be reported by phone or through a smartphone application associated with the company performing the testing.

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 of HPV associated with the highest risk of cancer, but sometimes also includes testing for HPV 45.

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.

Are test results accurate?

Although HPV testing is a routine aspect of cervical cancer screening, no test is 100% accurate. Both false positive and false negative results do occur. Doctors account for the risk of inaccurate results in several ways:

• The HPV test has a higher rate of false positives in young patients. This risk is one reason why HPV tests are not often recommended for people under 30 years old. Pap smears are typically used for cervical cancer screening in this age group.
• Cervical cancer screening using either an HPV test, Pap smear, or both may miss abnormal cell changes on the cervix, leading to a false negative result. Because HPV can take years, or even decades, to progress into cervical cancer, having cervical cancer screening at regular intervals means that later tests will likely detect the cell changes before they develop into cervical cancer.

While researchers are still learning about the accuracy of at-home HPV testing, results of large studies are promising.

Do I need follow-up tests?

If an HPV test or cotest result is negative, the need for follow-up testing depends on the results of a patient’s past cervical cancer screening tests. In many cases, patients may be advised by their doctor to wait five years before being screened for cervical cancer again.

Similarly, follow-up testing after a positive HPV test depends on the results of a Pap smear (if cotesting) and a person’s history of Pap and HPV testing. Based on these factors, as well as a patient’s age and health history, doctors estimate a patient’s immediate and five-year risk of developing severely abnormal cervical cells.

Depending on a patient’s 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 someone has a positive HPV test after previously testing negative, it usually means a new HPV infection. While most new HPV infections will be followed up by a negative result in 6 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: A recurrent positive result is a positive HPV test, followed by a negative HPV test, followed by another positive test result. Most recurrent positive infections are reactivations of dormant infections that were acquired soon after a person becomes 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, approximately 10% of patients with HPV infections on the cervix develop persistent infections. A persistent HPV infection is defined as two consecutive positive HPV tests at least 12 months apart. Patients with persistent HPV infections are at the highest risk of developing abnormal cell changes in the cervix, so it’s important for these patients to work with a doctor to plan for appropriate follow-up.

Questions for your doctor about test results

A doctor can address detailed questions about HPV and your HPV 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?

How is an HPV test different from a Pap smear?

High-risk strains of HPV can cause abnormal cell changes that may develop into cervical cancer over time. An HPV test detects infections with high-risk strains of HPV, while a Pap smear detects abnormal cell changes that have already developed on the cervix.

Other related tests

• Pap Smear (Pap Test)
• STD Testing
• Chlamydia Testing
• Herpes Testing
• HIV Tests
• Human Papillomavirus (HPV) Test
• Syphilis Tests
• Trichomonas Testing
• Gram Stain

These resources provide additional information about cervical cancer and screening tests:

American College of Obstetricians and Gynecologists: Abnormal Cervical Cancer Screening Test Results
CDC: Cervical Cancer
CDC: What Do My Cervical Cancer Screening Test Results Mean?
National Cancer Institute: Cervical Cancer Screening
National Cancer Institute: Understanding HPV and Pap Test Results
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