Should a partner be notified if a patient tests positive for Human Papillomavirus (HPV) on a Pap smear?

From the Guidelines

Yes, if you test positive for HPV on a Pap test, it's generally recommended to inform your sexual partner(s). HPV is a common sexually transmitted infection that can be passed between partners through skin-to-skin genital contact, even when using condoms. Most sexually active people will contract HPV at some point in their lives, and many clear the infection naturally within 1-2 years without developing symptoms. However, some high-risk HPV types can persist and potentially lead to cervical cancer in women or other cancers in both men and women. Partners who are informed can make decisions about their own healthcare, such as discussing testing options with their provider. For male partners, there is no FDA-approved HPV test, but they may benefit from knowing about potential exposure. For female partners, regular Pap tests are important for early detection of any cervical cell changes. Open communication about HPV status helps reduce transmission and promotes responsible sexual health practices, though it's worth noting that if you've been in a long-term relationship, your partner has likely already been exposed to the same HPV type 1.

Key Considerations

• HPV is very common, and most sexually active persons get HPV at some time in their lives, though most will never know it 1.
• No clinically validated test exists for men to determine if they have HPV infection, and high-risk HPV types seldom cause genital warts 1.
• Detection of high-risk HPV infection in a woman does not mean that the woman or her partner is engaging in sexual activity outside of a relationship, as HPV infection can be present for many years before it is detected 1.
• Providers should frame HPV positivity in a neutral, nonstigmatizing context and emphasize its common, asymptomatic, and transient nature 1.
• Having an HPV infection should not raise concerns about a male partner’s health, as HPV tests might become positive many years after initial exposure due to reactivation of latent infections in both male and female partners 1.

Recommendations for Healthcare Providers

• Counsel patients on the risks, uncertainties, and benefits of screening 1.
• Screen for tobacco use and perform cessation counseling, as smoking contributes to the progression of CIN 1.
• Communicate the meaning of both the cytology and HPV test results to patients at screening, and emphasize the importance of open communication about HPV status to reduce transmission and promote responsible sexual health practices 1.

From the Research

Notification of Partners

• The question of whether a partner should be notified if a patient tests positive for Human Papillomavirus (HPV) on a Pap smear is complex and has been studied in various contexts 2.
• A study published in 2009 found that most providers advise patients with cervical cancer screening tests suggestive of HPV infection to notify their sex partners and to refer them to a clinician, although the usefulness of this approach in preventing transmission or protecting the health of male partners is limited 2.
• The study also noted that because high-risk HPV is highly prevalent in the general population, usually transient, and rarely causes clinical symptoms, and because diagnostic and treatment options for HPV in men are lacking, partner notification is not useful for preventing transmission or protecting the health of male partners 2.

HPV Transmission and Partner Notification

• The study found that providers who perform reflex HPV testing were more likely to recommend that patients with an ASCUS Pap inform their partners of test results if an HPV test was positive than if it was negative (66%-83% vs. 29%-50%) 2.
• Similarly, providers who perform adjunct HPV testing were more likely to recommend that patients with a normal Pap inform their partners if an HPV test was positive than if it was negative (72%-92% vs. 30%-52%) 2.
• However, there is no clear evidence that notifying partners of a positive HPV test result reduces the risk of transmission or improves health outcomes for the partner 2.

HPV Vaccination and Treatment

• Other studies have focused on the use of HPV vaccination as a treatment modality for patients with cervical dysplasia, rather than on partner notification 3.
• A 2024 study found that the HPV vaccine was effective in clearing the virus in some patients, but the usefulness of the vaccine as a treatment option in exposed patients beyond age 26 is unclear 3.
• The study recommended that healthcare providers discuss the usefulness of the HPV vaccine with their unvaccinated patients 27 years and older who are at risk for cervical dysplasia 3.

HPV Testing and Screening

• Other studies have examined the use of HPV testing in cervical cancer screening, including the addition of an HPV test to the Pap test to screen women in their mid-30s for cervical cancer 4.
• A 2007 study found that the addition of an HPV test to the Pap test reduced the incidence of grade 2 or 3 cervical intraepithelial neoplasia or cancer detected by subsequent screening examinations 4.
• A 2014 study found that HPV type-specific infections influenced the detection of cervical precancer and cancer, and that positive results for high-risk HPV, especially HPV16, contributed independently to the risks of CIN2+ and CIN3+ 5.