HPV Testing Does Not Use "Titer" Levels - It Reports Positive or Negative Results
HPV DNA tests are qualitative, not quantitative - they report whether high-risk HPV types are detected (positive) or not detected (negative), rather than measuring antibody titers or viral load levels. 1
Understanding HPV Test Results
What HPV Tests Actually Measure
- FDA-approved HPV tests detect viral nucleic acid (DNA) from high-risk HPV types, not antibody titers like traditional serologic tests 1
- The Hybrid Capture 2 High-Risk HPV DNA test detects any of 13-14 high-risk HPV types as a pooled result 1
- The Cervista HPV 16/18 test provides type-specific detection for HPV types 16 and 18 specifically 1
- Results are reported as "positive" (HPV detected) or "negative" (HPV not detected), not as numerical titer values 1
Clinical Interpretation of HPV Test Results
- A positive HPV test indicates detection of high-risk HPV DNA, which requires clinical action based on the patient's age, cytology results, and screening context 1
- HPV 16 is the highest-risk type and warrants immediate colposcopy even with normal cytology 1
- HPV 18 has relatively high association with adenocarcinoma and also requires colposcopy regardless of cytology results 1, 2
- For other high-risk HPV types (not 16 or 18) with normal cytology, repeat testing in 1 year is typically recommended 1
Common Clinical Pitfalls
What HPV Testing Is NOT Used For
- HPV DNA testing should NOT be used for deciding whether to vaccinate - vaccination decisions are based on age and vaccination history, not test results 1
- HPV testing is NOT recommended for STD screening purposes - it is a cervical cancer screening tool, not a general STI test 1
- HPV testing should NOT be performed in adolescents aged <21 years - transient infections are extremely common in this age group and typically clear spontaneously 1
- HPV testing should NOT be used as a stand-alone primary screening test without cytology in most clinical contexts (though primary HPV screening protocols exist for women ≥30 years) 1
Understanding Test Limitations
- A positive HPV test does not indicate when infection occurred - HPV can remain latent for many years and reactivate, making it impossible to determine timing or source of infection 1
- Most HPV infections are transient - approximately 75% of HPV infections clear within 2-3 years in immunocompetent individuals 3, 4
- HPV positivity should be framed in a neutral, non-stigmatizing context when counseling patients, emphasizing its common and often transient nature 1
Age-Specific Testing Recommendations
Women Aged 21-29 Years
- HPV testing is recommended only for triage of ASC-US cytology results, not for routine primary screening 1
- Cytology alone every 3 years is the standard screening approach in this age group 1