What does a positive HPV (Human Papillomavirus) test and negative Pap smear result mean?

Understanding a Positive HPV Test with Negative Pap Smear

A positive HPV test with a negative Pap smear indicates the presence of high-risk HPV infection without current cellular abnormalities, requiring follow-up testing in 12 months rather than immediate colposcopy. This result is not uncommon and represents an important risk stratification in cervical cancer screening.

What This Result Means

• HPV Status: The test detected one or more of 14 high-risk HPV types (16,18,31,33,35,39,45,51,52,56,58,59,66,68) in your cervical cells 1.
• Cytology Status: Your Pap smear (cytology) is negative, meaning no abnormal cellular changes were detected at this time.
• Risk Assessment: This combination indicates you have an HPV infection that has not yet caused cellular changes visible on cytology.

Clinical Significance

• Women with high-risk HPV and normal cytology have a higher risk of developing cervical abnormalities than HPV-negative women, but lower risk than those with both positive HPV and abnormal cytology 1.
• Studies show that persistent high-risk HPV infection significantly increases the risk of developing cervical abnormalities (hazard ratio 28.2) compared to women without persistent infection 2.
• The 16-year cumulative risk of developing cervical cancer varies by HPV type: 13.5% for HPV16, 10.3% for HPV58, and 4.0% for other carcinogenic types, compared to only 0.26% for HPV-negative women 3.

Recommended Management

1. Follow-up Testing:

   • Return for repeat co-testing (both HPV and Pap) in 12 months 1.
   • Earlier guidelines suggested 6 and 12-month follow-up, but current recommendations favor a single 12-month follow-up 1.

2. At 12-month Follow-up:

   • If both tests are negative: Return to routine screening 4.
   • If HPV remains positive or cytology becomes abnormal: Referral for colposcopy 4.

3. Important Note: Do not proceed directly to colposcopy based on this result alone. The risk of CIN3+ (high-grade precancer) after an HPV-positive/cytology-negative result is below the threshold that would warrant immediate colposcopy 1.

Key Points to Understand

• Common Finding: HPV infection is extremely common among sexually active individuals. Most infections (about 90%) clear naturally within 1-2 years 1.
• Not an STD: While HPV is sexually transmitted, a positive test does not indicate infidelity or recent sexual activity. The virus can remain dormant for many years before detection 1.
• No Symptoms: HPV infection typically has no symptoms and most people never know they have it 1.
• No Treatment Needed: There is no treatment for the HPV infection itself; follow-up is to monitor for any cellular changes that might develop 1.

Common Pitfalls to Avoid

1. Unnecessary Anxiety: A positive HPV test does not mean you have or will develop cancer. It identifies women who may benefit from more vigilant follow-up.

2. Skipping Follow-up: The most important action is to return for your 12-month follow-up testing. Studies show that women with persistent HPV infection have significantly higher risk than those whose infections clear 3.

3. Immediate Colposcopy: Referring all HPV-positive/cytology-negative women for immediate colposcopy would lead to unnecessary procedures, as most infections will clear without causing precancerous changes 5.

4. Ignoring Age Factors: The risk associated with persistent HPV increases with age. The cumulative cervical cancer risks following persistent carcinogenic HPV infections are 5.5% for women 30-44 years, 14.4% for women 45-54 years, and 18.1% for women 55+ years 3.

By following the recommended follow-up schedule, you're taking the appropriate steps to monitor this finding while avoiding unnecessary procedures.