HPV Testing When a Sexual Partner Tests Positive
HPV testing is not recommended for sexual partners of individuals who test positive for HPV, regardless of sex, age, or risk factors. 1
Key Principle: Partner Testing is Not Indicated
The fundamental issue is that HPV testing in sexual partners serves no clinical purpose because:
- High-risk HPV is highly prevalent in the general population and usually transient 2
- HPV rarely causes clinical symptoms that require intervention 2
- Diagnostic and treatment options for HPV in men are lacking 2
- Partner notification does not prevent transmission or protect the health of male partners 2
- Most HPV infections are sexually transmitted and concordance between partners is common, meaning if one partner has HPV, the other likely has been exposed 3, 4
What Testing IS Recommended Instead
For Women (Based on Age)
Women aged 21-29 years:
- Cervical cytology (Pap smear) every 2-3 years 5
- High-risk HPV testing is not recommended as routine screening in this age group 1
- HPV testing only used for triage of ASC-US results in women >25 years 1
Women aged ≥30 years:
- Co-testing with cytology plus high-risk HPV testing every 3 years (preferred) 1
- Alternative: cytology alone every 3 years 5
- Alternative: primary HPV testing with cytology reflex 5
- If both cytology and HPV are negative, repeat co-testing at 3 years 1
For Men
No routine HPV testing is recommended for men in any circumstance 1, including:
- Heterosexual men with HPV-positive female partners
- Men who have sex with men (MSM)
- Immunocompromised men
However, specific screening IS indicated for high-risk men:
Anal cytology (anal Pap test) should be performed for: 1
- HIV-infected MSM
- HIV-infected women with history of receptive anal intercourse or abnormal cervical Pap results
- All HIV-infected persons with genital warts
- If anal cytology shows abnormalities, proceed to high-resolution anoscopy with biopsy 1
Special Populations Requiring Enhanced Screening
HIV-infected women: 1
- Cervical Pap test at initiation of care
- Repeat at 6 months
- Then annually if results remain normal
- Consider colposcopy for any epithelial cell abnormalities (ASC-US, ASC-H, LSIL, HSIL)
Immunocompromised individuals (organ transplant, chronic corticosteroids, chemotherapy): 1
- Screen twice during first year after diagnosis
- Then annually thereafter
- No specific age to stop screening as long as in reasonably good health
Common Clinical Pitfall
Many providers incorrectly recommend partner testing: A nationally representative survey found that 48-73% of providers across specialties encourage women with abnormal Pap or positive HPV tests to have their partners see a clinician 2. This practice is not evidence-based and should be avoided because it provides no clinical benefit and may cause unnecessary anxiety 2.
What Partners Should Actually Do
Instead of HPV testing, partners should focus on:
- HPV vaccination if age-eligible (females and males aged 9-26 years; males 22-26 if MSM or immunocompromised) 1, 6
- Routine STI screening for gonorrhea, chlamydia, syphilis, and HIV based on sexual activity and risk factors 1, 6
- Condom use, which reduces HPV transmission by approximately 70% 5
- Age-appropriate cancer screening (cervical cytology for women starting at age 21, anal cytology for high-risk individuals as outlined above) 5, 1
Visual Diagnosis Only
For genital warts: Diagnosis is made by visual inspection only; high-risk HPV testing is not recommended 1. Genital warts are typically caused by low-risk HPV types (6 and 11), not the high-risk oncogenic types.