Can a 26-year-old woman who has never been sexually active do a self-collection Human Papillomavirus (HPV) test instead of a Pap smear?

Self-Collection HPV Testing for a 26-Year-Old Never Sexually Active Woman

Self-collection HPV testing is not recommended for a 26-year-old woman who has never been sexually active, and she should instead follow standard cervical cancer screening guidelines starting with a Pap test at age 21 regardless of sexual history.

Current Screening Recommendations

According to the most recent guidelines, cervical cancer screening should:

• Begin at age 21 regardless of sexual history or activity 1
• For women aged 21-29: Cytology (Pap test) alone every 3 years 2, 1
• For women aged 30-65: Either HPV and cytology co-testing every 5 years (preferred) or cytology alone every 3 years 1

Self-Collection HPV Testing Status

The CDC's 2021 Sexually Transmitted Infections Treatment Guidelines explicitly state that:

• "Self-collection for HPV testing is not cleared by FDA or recommended by U.S. medical organizations" 2
• HPV testing should not be performed for "testing persons aged <25 years as part of routine cervical cancer screening" 2

Risk Assessment for Never Sexually Active Women

For women who have never been sexually active:

• HPV is primarily transmitted through sexual contact
• The risk of cervical cancer is extremely low in women who have never been sexually active
• However, guidelines still recommend beginning screening at age 21 regardless of sexual history 1

Appropriate Screening Approach

For this 26-year-old woman:

1. She should follow standard screening guidelines despite never having been sexually active
2. She should receive a Pap test every 3 years as recommended for women aged 21-29 2, 1
3. Self-collection HPV testing is not an appropriate substitute for Pap testing in her case

Common Pitfalls to Avoid

• Misconception about sexual activity requirements: Many believe screening is unnecessary without sexual activity, but guidelines recommend screening regardless of sexual history 1
• Overreliance on HPV testing alone: HPV testing alone is not recommended for women under 30 2
• Patient preference for self-collection: Despite potential convenience, self-collection HPV testing is not FDA-cleared or recommended by U.S. medical organizations 2
• Lack of awareness about screening guidelines: Many women (92.2%) remain unaware of current screening recommendations and options 3

Conclusion

While HPV testing is becoming more prevalent in cervical cancer screening protocols, self-collection HPV testing is not currently recommended or FDA-cleared as a substitute for Pap testing. The 26-year-old woman should follow standard screening guidelines with a provider-administered Pap test every 3 years, regardless of her sexual history.