Which patients should be screened for Human Papillomavirus (HPV) infections and what are the screening parameters?

HPV Screening Recommendations

HPV screening should be performed in individuals aged 25-65 years with primary HPV testing every 5 years as the preferred method, while those with HIV should be screened annually starting 1 year after sexual debut or at HIV diagnosis. 1

General Screening Parameters by Population

Adults with Average Risk

• Cervical cancer screening should begin at age 25 years for individuals with a cervix 1
• Primary HPV testing is the preferred screening method for individuals aged 25-65 years 1
• HPV testing can be used alone for cervical cancer screening or with cytology (cotesting) for those aged ≥30 years to 65 years 1
• HPV testing can also be used after a cytology test result of atypical squamous cells of undetermined significance (ASC-US) among persons aged >25 years (reflex HPV testing) 1

Adolescents (Under 21 years)

• HPV testing and cervical cancer screening are NOT recommended in immunocompetent adolescents 1
• HPV infections in adolescents have high prevalence but are more likely to regress naturally compared to infections in older individuals 1
• Screening in this age group has little demonstrated benefit in reducing invasive disease 1

Individuals with HIV

• Screening should begin 1 year after onset of sexual activity but no later than age 21 years 1
• Screening should be performed at the time of initial HIV diagnosis 1
• Annual screening is recommended; after 3 consecutive normal results, screening can be extended to every 3 years 1
• Conventional or liquid-based cytology should be used as primary screening; primary HPV testing alone is not recommended 1
• Cotesting (cytology and HPV test) can be done in individuals aged ≥30 years with HIV 1
• Lifelong screening is recommended for persons with HIV infection 1

Pregnant Individuals

• Screening should be performed at the same intervals as those who are not pregnant 1
• A swab, Ayre's spatula, or cytobrush can be used for obtaining cytology samples during pregnancy 1

Specific HPV Testing Parameters

Types of Tests

• FDA-cleared HPV tests detect viral DNA or messenger RNA 1
• Tests like Cobas 4800 HPV test and Onclarity HPV test can detect 14 oncogenic HPV types (16,18,31,33,35,39,45,51,52,56,58,59,66, and 68) 1
• These tests are only FDA cleared for use with cervical specimens, not oral or anal specimens 1
• Testing for non-oncogenic HPV types (e.g., types 6 and 11) is not recommended 1

Post-Treatment Surveillance

• HPV testing is valuable for surveillance after treatment of cervical precancers 1
• Testing should occur at least 6 months after treatment to allow enough time for clearance 1
• In the absence of risk factors, HPV testing should occur 12 months after treatment 1

Important Counseling Points

• HPV is a common infection that is often controlled by the body without medical interventions 1, 2
• A positive HPV test does not mean a person has cancer 1
• HPV infections are often shared between partners, and it is often not possible to know the origin of infection 1
• HPV tests might become positive many years after initial exposure due to reactivation of latent infections 1
• Most HPV infections clear spontaneously within 12-24 months post-infection 3, 2
• Only persistent infections increase risk for developing cervical precancerous lesions and cancer 3, 2

Management of Sex Partners

• Sex partners do not need to be tested for HPV 1, 4
• Female sex partners of men who disclose they had a previous female partner with HPV should be screened at the same intervals as women with average risk 1
• Condoms might lower the risk for HPV infection when used correctly and consistently, but may not fully protect as HPV can infect areas not covered by condoms 1

Common Pitfalls to Avoid

• Assuming HPV infection indicates sexual infidelity, as the virus can remain dormant for long periods 4
• Using HPV DNA testing for screening in men, partners of women with HPV, or for conditions other than cervical cancer 4
• Performing cesarean delivery solely to prevent HPV transmission to newborns 4
• Using acetic acid soaks as a screening test for subclinical HPV infection due to high false-positive rates 4
• Screening immunocompetent adolescents, as infections in this age group are likely to regress naturally 1
• Failing to recognize that HPV types causing genital warts (6 and 11) differ from high-risk types that can cause cancer 4, 2