HPV Testing for Cervical Cancer Screening in Females
HPV testing should begin at age 30 years, not before, and should be used either alone every 5 years or in combination with cytology (cotesting) every 5 years. 1
Age-Specific Screening Recommendations
Women Under Age 21
- Do not screen with HPV testing or cytology, regardless of sexual history 1
- Screening before age 21 causes more harm than benefit due to unnecessary treatment of lesions that would naturally regress 1
Women Ages 21-29 Years
- HPV testing is NOT recommended in this age group 1
- Screen with cervical cytology alone every 3 years 1
- HPV infection is extremely common and typically transient in younger women, making HPV testing inappropriate due to poor specificity 2
- Cotesting (cytology plus HPV) is specifically not recommended for women under 30 1
Women Ages 30-65 Years
This is when HPV testing becomes appropriate. You have three equally acceptable options 1:
- Cervical cytology alone every 3 years
- High-risk HPV testing alone every 5 years
- Cotesting (cytology + HPV) every 5 years (preferred option) 1
The combination of cytology and HPV testing achieves 96-100% sensitivity for detecting CIN 2/3 and cancer in this age group 2. At age 30 and older, HPV testing provides substantial gains in sensitivity over cytology alone with minimal reduction in positive predictive value 3.
Women Over Age 65
- Discontinue all screening (including HPV testing) if adequate prior screening has been documented and the woman is not at high risk 1
- Adequate prior screening means 3 consecutive negative cytology tests or 2 consecutive negative cotests within the past 10 years, with the most recent test within 5 years 1
Critical Caveats
When HPV Testing Should NOT Be Used
HPV testing is inappropriate for 1:
- Women under age 21 (any indication)
- Women ages 21-29 for routine screening
- Stand-alone primary screening without cytology (though newer guidelines now permit this at age 30+) 1
- STD screening purposes
- Deciding whether to vaccinate against HPV
- Triaging ASC-H or HSIL cytology results
Special Populations Requiring Different Approaches
Standard HPV testing recommendations do not apply to 1:
- Women with HIV or other immunocompromising conditions (require more frequent screening, often annually) 1
- Women with history of CIN 2/3 or cervical cancer
- Women with in utero diethylstilbestrol exposure
- These women need individualized, more intensive surveillance 1
HPV Testing for Triage
HPV testing is recommended for 1:
- Triage of ASC-US cytology results in women age 21 and older
- Follow-up testing after treatment of high-grade lesions 2
Post-Hysterectomy
- Discontinue all screening (including HPV testing) if hysterectomy included cervix removal and there is no history of high-grade precancerous lesions or cervical cancer 1