HPV Testing Procedure and Recommendations
HPV testing is not performed through blood tests but is conducted using cervical specimens only, as FDA-cleared HPV tests are only approved for cervical specimens, not blood, oral, or anal specimens. 1
Appropriate Clinical Uses for HPV Testing
HPV tests are FDA-cleared for specific clinical scenarios:
- Cervical cancer screening as a primary test 1
- Cervical cancer screening with a cytology test (co-testing) 1
- Triage of some abnormal cervical cytology results 1
- Follow-up after abnormal screening test results 1
- Follow-up after a colposcopy in which no CIN 2 or CIN 3 is found 1
- Follow-up after treatment of cervical precancers 1
FDA-Cleared HPV Tests
Several HPV tests are available for clinical use in the United States:
Primary screening tests: Detect 14 oncogenic HPV types (16,18,31,33,35,39,45,51,52,56,58,59,66, and 68) 1
Other HPV tests: For use with cytology or for triage of abnormal results 1
Situations Where HPV Testing Should NOT Be Performed
HPV testing should not be performed in the following scenarios:
- Deciding whether to vaccinate against HPV 1
- Testing for low-risk (nononcogenic) HPV types (e.g., types 6 and 11) 1
- Providing care to persons with genital warts or their partners 1
- Testing persons aged <25 years as part of routine cervical cancer screening 1
- Testing oral or anal specimens 1
- Blood testing for HPV is not an FDA-approved method 1
Age-Specific Recommendations
- Women <21 years: HPV testing not recommended due to high prevalence and transient nature of infections 1, 2
- Women 21-29 years: HPV testing only for triage of ASC-US cytology results 1
- Women ≥30 years: HPV testing can be used as primary screening or co-testing with cytology 1
- Adolescents with HIV: Screening should begin 1 year after onset of sexual activity, regardless of age 1
Special Populations
HIV-Positive Individuals
- Conventional or liquid-based cytology should be used; primary HPV testing is not recommended 1
- Co-testing (cytology and HPV test) can be done in individuals aged ≥30 years with HIV 1
- Annual screening recommended; after 3 consecutive normal results, can increase to every 3 years 1
- Lifelong screening is recommended 1
Sample Collection
- HPV tests are performed on cervical specimens, not blood 1
- Samples are collected during a pelvic examination, similar to a Pap test 1
- Self-collection for HPV testing is not FDA-cleared or recommended by U.S. medical organizations, though it has potential for increasing screening rates 1
Follow-Up Management
- If HPV testing is positive for types 16 or 18, colposcopy is recommended regardless of cytology results 1, 3
- For HPV 18 positive cases, endocervical sampling is acceptable at colposcopy due to association with adenocarcinoma 1, 3
- If positive for other high-risk HPV types with normal cytology, return in 1 year is recommended 1, 3
- Colposcopy is always recommended for two consecutive HPV-positive tests 1, 3
Common Pitfalls to Avoid
- Do not order blood tests for HPV detection - HPV testing is only FDA-cleared for cervical specimens 1
- Do not use HPV testing to decide whether to vaccinate 1
- Do not test for low-risk HPV types (6 and 11) as they are not oncogenic 1, 3
- Avoid HPV testing in persons under 25 years for routine screening 1
- Do not test oral or anal specimens for HPV as these tests are not FDA-cleared for this purpose 1
Clinical Implications
- HPV testing has higher sensitivity than cytology for detecting cervical lesions 2, 4
- HPV 16 and 18 are responsible for approximately 70% of cervical cancers worldwide 5
- Persistent infection with high-risk HPV types is necessary for development of cervical cancer 6, 5
- HPV testing in conjunction with cytology improves detection of precancerous lesions 7, 4