What is the procedure for testing for Human Papillomavirus (HPV) in individuals, particularly those who are sexually active?

How to Test for HPV

HPV testing is performed using FDA-cleared assays that detect viral DNA or messenger RNA from cervical specimens collected during a pelvic examination, but testing is only recommended for specific populations and clinical scenarios—not for routine screening in all individuals. 1

Who Should Be Tested

Age-Based Recommendations

• Ages 25-65 years: Primary HPV testing every 5 years is the preferred screening method for cervical cancer 2
• Ages 30-65 years: Co-testing (Pap test plus HPV DNA test) every 5 years is an alternative option 3
• Ages 25-29 years: Pap test alone every 3 years; HPV testing is not recommended for primary screening in this age group 3
• Under age 25: HPV testing and cervical cancer screening are NOT recommended in immunocompetent individuals, as infections in this age group typically regress spontaneously 1, 2

Special Populations

• HIV-positive individuals: Screen annually starting 1 year after sexual debut or at HIV diagnosis using conventional or liquid-based cytology (Pap test); primary HPV testing alone is not recommended 1, 3
• Pregnant individuals: Screen at the same intervals as non-pregnant individuals using a swab, Ayre's spatula, or cytobrush 1, 2

How the Test Is Performed

Specimen Collection

• Cervical specimens only: All FDA-cleared HPV tests are designed for use with cervical specimens collected during pelvic examination 1
• Collection methods: A healthcare provider collects cells from the cervix using a swab, spatula, or cytobrush during a speculum examination 1
• Not approved for other sites: HPV tests are not FDA-cleared for oral or anal specimens 1, 4

Laboratory Testing

• FDA-cleared assays: Tests detect viral DNA or messenger RNA for high-risk HPV types 1, 2
• Approved tests include: Cobas 4800 HPV test and Onclarity HPV test, which detect 14 oncogenic HPV types (16,18,31,33,35,39,45,51,52,56,58,59,66, and 68) plus individual identification of types 16 and 18 1, 2
• CLIA-certified laboratories: All HPV testing must be performed in certified laboratories 3

Clinical Indications for HPV Testing

Appropriate Uses

• Primary cervical cancer screening in individuals aged 25-65 years 1, 2
• Reflex testing after atypical squamous cells of undetermined significance (ASC-US) cytology in persons aged >25 years 1, 3
• Post-treatment surveillance at least 6-12 months after treatment of cervical precancers 2, 3
• Follow-up after colposcopy when no CIN 2 or CIN 3 is found 1, 3

When NOT to Test

• Men: No clinically validated HPV test exists for men, and routine testing is not recommended 1, 4
• Partners of HPV-positive individuals: Sex partners do not need to be tested for HPV 1, 2
• Adolescents under 21: Testing is not recommended in immunocompetent adolescents 1, 2
• Low-risk HPV types: Testing for non-oncogenic types (e.g., types 6 and 11 that cause genital warts) is not recommended 1, 2
• Vaccination decisions: HPV testing should not be used to decide whether to vaccinate 1, 2
• Oral or anal specimens: No FDA-cleared tests exist for these sites 1, 4

Important Counseling Points

Understanding Test Results

• Positive test does not mean cancer: A positive HPV test indicates infection with high-risk types but does not mean cancer is present 1, 2
• Shared infection: HPV infections are often shared between partners, and it's usually impossible to determine the origin or timing of infection 1, 2
• Latent reactivation: HPV tests may become positive years after initial exposure due to reactivation of dormant infections 1, 2

Partner Management

• No testing needed: Partners of HPV-positive individuals do not require HPV testing 1, 4, 2
• Not indicative of infidelity: A diagnosis of HPV in one partner does not indicate sexual infidelity, as both partners are usually already infected by the time of diagnosis 1, 4
• Condom use: Correct and consistent condom use may lower HPV transmission risk but is not fully protective, as HPV can infect areas not covered by condoms 1, 2

Common Pitfalls to Avoid

• Do not screen men routinely: There is no FDA-approved HPV test for men, and screening is not clinically useful 4, 5
• Do not test adolescents: HPV infections in those under 21 typically regress without intervention 1, 2
• Do not test for low-risk types: Testing for HPV types 6 and 11 provides no clinical benefit 1, 4, 2
• Do not use for STD screening: HPV testing is specifically for cervical cancer screening, not general STD screening 3
• Do not assume infidelity: HPV can remain dormant for extended periods, making it impossible to determine when infection occurred 2