Why should I take an HPV test?

Cervical cancer is the 4^th most common cancer in women. Luckily, it is one of the most successfully treatable forms of cancer, but ONLY if detected and treated early (1). And this is where the problem lies—early cervical cancer often doesn’t cause any symptoms, so how can it be detected?

More than 99% of cervical cancer cases are linked to a persistent infection with one of the high-risk human papillomavirus (HPV) genotypes. And these infections can be simply detected by lab analyses of a cervical swab (1).

What is HPV?
Human papillomavirus (HPV) is a common sexually transmitted DNA virus. It is transmitted through vaginal, anal, or oral sex, and can be spread even when an infected individual does not show any symptoms. Although most women effectively clear HPV infections within 6 to 12 months (2), there are specific HPV genotypes that increase the risk of cervical cancer (1).

Which HPV genotypes are high-risk for cervical cancer?
There are more than 100 genotypes of HPV, of which 14 are considered high-risk for cervical disease – genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. Women who have persistent infection with one of these pathogenic genotypes have an increased risk for cervical carcinoma or severe dysplasia (3).

What will an HPV test tell me?
The HPV test that we offer here detects the presence of nucleic acids from the 14 high-risk HPV genotypes. If any high-risk HPV nucleic acids are detected in your cervical swab (a positive test result), it means you have an active HPV infection. However, this does not mean that you have cervical cancer.

Follow-up testing is recommended for any positive results, with protocols varying based on the results of recent pap smears. Another HPV test and/or pap smear in a shorter time period from routine testing may be all that is required. Alternatively, a colposcopy to further examine the cervix, vagina, or vulva can be used to detect abnormal cells or blood vessels. Other options include tissue biopsies, removal of abnormal cervical cells, and referral to a gynecologist (4).

How often should I take an HPV test?
HPV testing for the 14 high-risk HPV genotypes is recommended for screening for cervical cancer in women aged 30 years and older. Routine screening for HPV is not recommended for women under 30 years of age, as HPV is very common in young people, and will often clear without intervention within one to two years. However, women should still start getting Pap tests from age 21 to look for any cell changes on the cervix that might become cervical cancer if not treated correctly (5).

There are different cervical cancer screening options available for women aged 30–65 years. Pap tests alone are generally recommended once every three years (assuming results are normal), while HPV tests alone are recommended once every five years (assuming results are normal). Often an HPV test is conducted at the same time as a Pap test (called co-testing) and if both results are normal, further screening is generally not required for another five years (5).

Although HPV testing is often conducted at the same time as a routine Pap test, self-collected cervical swabs (like available here) are an efficient alternative with many studies showing similar diagnostic test accuracies as clinician-sampled HPV tests (6).

References:
1. Cervical Cancer. WHO.
2. Cuschieri KS, Whitley MJ, & Cubie HA. (2004). Human papillomavirus type-specific DNA and RNA persistence–implications for cervical disease progression and monitoring. J Med Virol, 73 (1), 65-70.
3. Kjaer SK, et al. (2002). Type-specific persistence of high-risk human papillomavirus (HPV) as an indicator of high grade cervical squamous intraepithelial lesions in young women: population-based prospective follow-up study. BMJ, 325 (7364), 572-579.
4. Human Papillomavirus (HPV) Treatment and Care. (July 2021). CDC.
5. What should I know about screening? Cervical Cancer, Basic Information. (January 2021). CDC.
6. Ogale Y, Yeh PT, Kennedy CE, Toskin I, & Narasimhan M. (2019). Self-collection of samples as an additional approach to deliver testing services for sexually transmitted infections: a systematic review and meta-analysis. BMJ Global Health, 4, e001349.