Category Archives: HPV

Cervical cancer used to be the leading cause of cancer-associated deaths in women in the United States. But since the introduction of routine Pap smears, both the number of cervical cancer deaths and the number of cervical cancer cases have decreased significantly (1).

What is a Pap smear?
A Pap smear (or Pap test) is conducted by a doctor to check for abnormalities in the cervix. A speculum is inserted into the vagina to widen it and allow the doctor to gently collect cells from the cervix using a small brush. The whole process only takes a few minutes and doesn’t usually cause any pain. The collected cells are then examined under a microscope to check for cervical cancer or cell changes that may lead to cervical cancer (2).

Are there other tests to detect cervical cancer early?
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; hence why HPV testing is an alternative option to screen for cervical cancers at an early stage (4).

For more information about HPV testing and cervical cancer, see our previous articles:

• Why should I take an HPV test?
• HPV Quick Facts
• What is cervical cancer?
• Are all HPV types associated with an increased risk of cervical cancer?

How often should I get a Pap smear and HPV test?
The CDC recommendations for Pap smear frequency are:

• Start getting Pap smears at 21 years of age
• 21–29 years of age: Get a Pap smear every three years
• 30–65 years of age: There are three options for this age bracket:
  • A Pap smear every three years
  • An HPV test every five years
  • Co-testing (HPV test + Pap smear) every five years
• Older than 65 years of age: Screening is no longer usually necessary.

These recommendations are assuming that each Pap smear or HPV test is returning normal results. If there are any abnormalities or other risk factors (e.g., immunocompromised), more frequent testing and other procedures may be required (3).

Can I take an HPV test from home?
Although Pap smears require a visit to the doctor, HPV testing is now available from a self-collected cervical swab, such as our at-home HPV test available here.

After ordering an HPV test, the testing kit will be promptly mailed to you. The test kit contains all the instructions and supplies required for collection. The cervical swab sample can be painlessly collected in the privacy of your own home and only takes a few minutes. The sample is then mailed back to our laboratory for a very accurate, fully automated analysis that detects nucleic acids from the 14 high-HPV genotypes that are associated with an increased risk of cervical cancer.

References:
1. Cervical Cancer Statistics. (Reviewed June 2021). CDC.
2. Pap smear. NIH, National Cancer Institute.
3. What should I know about screening? (Reviewed Jan 2021). CDC.
4. Cervical Cancer. WHO.

Related Tests

• Human Papillomavirus (HPV) High-Risk Test

No, there are more than 100 genotypes of HPV but only 14 are considered high-risk for cervical cancer.

What exactly is cervical cancer?
Cervical cancer occurs when malignant (cancer) cells form in the tissues of the cervix. The cervix is the lower, narrow end of the uterus (womb where a fetus grows). It connects the vagina (birth canal) to the upper part of the uterus (1). More information about cervical cancer is available here.

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. It is the most common sexually transmitted disease in the United States, with an estimated 43 million HPV cases in 2018. Almost every non-vaccinated sexually active individual will get HPV at some time in his or her life (2). See our previous article “HPV Quick Facts” for more information.

Which HPV genotypes are associated with an increased risk of cervical cancer?
Genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68 are considered “high-risk” genotypes. Nearly all cervical cancers are caused by a persistent infection with one of these genotypes. The persistent viral infection can cause changes in the cervical cells, called dysplasia. Although dysplasia itself is not cancer, it can sometimes become cancer (3).

Do the other genotypes cause any health issues?
Some HPV types infect mucosal surfaces, including the “high-risk” types mentioned above, as well as “low-risk” types, which are not linked to cancer risk but can cause genital warts and papillomas (warts) in other mucosal areas (e.g., respiratory tract) instead. Other HPV types are considered cutaneous types as they infect the skin and cause “common” warts on the skin instead, most commonly the hands and feet (4).

Is there a test for HPV?
There are no tests to find out a person’s “HPV status”, as there are so many different types of HPV. However, nucleic acid tests (such as this one) are available to accurately identify individuals who are infected with one of the 14 high-risk HPV strains. Detection of HPV nucleic acid (a positive test result) is indicative of an active HPV infection but does not mean that cervical dysplasia or cervical cancer is present.

Trying to decide if you should take an HPV? Read our previous article “Why should I take an HPV test?” to learn all about the health benefits.

How can I protect myself from HPV?
Anybody who is sexually active is at risk of catching HPV, as HPV is a very common sexually transmitted infection.

Using condoms correctly lowers the risk of catching HPV, but HPV can still infect areas that are not covered by a condom, so condoms do not provide full protection.

HPV vaccination is safe and effective to prevent diseases (including cancer) caused by HPV. It is recommended at age 11 or 12 years, and for everyone through to 26 years, if not vaccinated already. Vaccination for individuals older than 26 years provides less benefit, as most sexually active adults have already been exposed to HPV (2).

Routine screening for cervical cancer with pap smears is also recommended for women aged 21–65 years (2). 

References:
1. Basic information about cervical cancer. CDC. Reviewed Jan 2021.
2. Genital HPV Infection – Fact Sheet. (2021, January). CDC.
3. 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.
4. Cervical Cancer. WHO.
5. HPV and HPV Testing. (Revised July 2020). American Cancer Society. 

Related Tests

• Human Papillomavirus (HPV) High-Risk Test

Cervical cancer occurs when malignant (cancer) cells form in the tissues of the cervix. It used to be the leading cause of cancer death in women in the United States, but regular screening (Pap tests) has significantly decreased the number of cervical cancer deaths (1).

What is cancer?
Cancer occurs when cells in the body grow out of control and start spreading to places that they normally wouldn’t grow. Normal cells in the body only grow when they receive signals to tell them to, and they stop dividing when they receive signals for apoptosis (programmed cell death). In contrast, cancer cells grow even when there are no growth signals and continue growing even when they are signaled to stop growing (2).

Cancer cells can also tell blood vessels to grow towards them to provide extra nutrients and oxygen, as well as tricking the immune system into protecting the tumor rather than attacking it. Cancer cells can spread into other areas of the body and they also accumulate lots of changes in their chromosomes, including large duplications and deletions (2).

Where does cervical cancer occur?
Cancer can start almost anywhere in the body, and the place that it starts is what the cancer is called, even if it then spreads elsewhere in the body. When cancer starts in the cervix, it is called cervical cancer. The cervix is the lower, narrow end of the uterus (womb where a fetus grows). It connects the vagina (birth canal) to the upper part of the uterus (3).

What are the symptoms of cervical cancer?
Cervical cancer usually develops slowly over many years. Before cancer cells form, a process called dysplasia occurs, where abnormal (but non-cancerous) cells appear in the cervical tissue (4). There are no symptoms associated with these abnormal cells, and often there are also no symptoms associated with the early stages of cervical cancer. Cervical cancer is one of the most successfully treatable forms of cancer, but ONLY if detected and treated early (5). This is why routine screening is highly recommended (see ‘How can I reduce my risk of cervical cancer?’ section below).

Advanced cervical cancer can cause abnormal bleeding or discharge from the vagina, such as bleeding after sex. These symptoms can also be caused by other things, but if you experience these symptoms, it is very important that you see your healthcare professional for an examination and consultation (3).

How common is cervical cancer?
Due to increased access to screening tests (Pap smears and HPV tests), the incidence of cervical cancer and associated deaths in the United States is now a lot lower than it used to be. In 2018, 12,733 new cervical cancer cases were reported in the United States, with 4,138 deaths from cervical cancer (6).

What are the risk factors for cervical cancer?
Human papillomavirus (HPV) infection is the cause of nearly all cervical cancers. But that’s not to say that everyone who has an HPV infection will get cervical cancer! HPV is a very common sexually transmitted virus. There are more than 100 genotypes of HPV, of which 14 are considered high-risk for cervical disease. Women who have persistent infection with one of the high-risk genotypes have an increased risk of cervical cancer (7). Read our HPV Quick Facts article for more information.

Other factors that are associated with an increased risk of cervical cancer include (3):

• HIV infection reduces the body’s ability to defend itself from pathogens, including HPV
• Other health issues that inhibit the body’s normal immune response
• Smoking
• Extended use of birth control pills (5+ years)
• Giving birth to 3 or more children
• Having several sexual partners

How can I reduce my risk of cervical cancer?

• Get the HPV vaccine. This vaccine is recommended at 11–12 years of age and for anyone through to 26 years if they have not been vaccinated already. It is of less benefit for adults over 26 years, as most people of this age have already been exposed to HPV. The vaccine prevents new HPV infections but does not treat existing infections (3).
• Get regular Pap tests (Pap smears). These are generally recommended once every three years (assuming results are normal) from 21 years of age. Pap tests detect abnormal cell changes in the cervix that may lead to cervical cancer (3).
• Take an HPV test, such as this one here. These tests detect the 14 high-risk HPV genotypes, which are associated with an increased risk of cervical cancer. HPV tests are often recommended from ages 30–65 years (3).
• Abstain from smoking
• Use condoms during sex
• Limit your number of sexual partners

References:
1. Cervical Cancer Statistics. CDC. Reviewed June 2021.
2. What is cancer? NIH, National Cancer Institute. Updated May 2021.
3. Basic information about cervical cancer. CDC. Reviewed Jan 2021.
4. Cervical Cancer Treatment (PDQ®)–Patient Version. NIH, National Cancer Institute. Updated August 2021.
5. Cervical Cancer. WHO.
6. S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool, based on 2020 submission data (1999-2018): U.S. Department of Health and Human Services, CDC, Released in June 2021.
7. 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.

Related Tests

• Human Papillomavirus (HPV) High-Risk Test

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 (1), there are specific HPV genotypes that increase the risk of cervical cancer (2).

How common is HPV?
HPV is the most common sexually transmitted disease in the United States. An estimated 43 million Americans were infected with HPV in 2018, with many infections among people in their late teens and early 20s. Almost every non-vaccinated sexually active individual will get HPV at some time in his or her life (3).

Are there different types of HPV?
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 (4).

What are the symptoms of an HPV infection?
Usually, HPV does not cause any symptoms and is effectively cleared without any medical interventions. However, in some cases, warts can occur on the cervix, vagina, anus, or back of the throat. These warts may lead to itching or burning sensations and unusual discharges.

Other types of HPV can cause cell changes that lead to cervical cancer and other cancers of the vulva, vagina, penis, anus, or throat. Generally, the types of HPV that cause warts differ from those that cause cancer (3).

Who is at risk of HPV? How can I lower my risk?
Anybody who is sexually active is at risk of catching HPV, as HPV is a very common sexually transmitted infection.

Using condoms correctly lowers the risk of catching HPV, but HPV can still infect areas that are not covered by a condom, so condoms do not provide full protection.

HPV vaccination is safe and effective to prevent diseases (including cancer) caused by HPV. It is recommended at age 11 or 12 years, and for everyone through to 26 years, if not vaccinated already. Vaccination for individuals older than 26 years provides less benefit, as most sexually active adults have already been exposed to HPV (3).

Routine screening for cervical cancer with pap smears is also recommended for women aged 21–65 years (3). 

How is HPV diagnosed?
Most HPV infections are asymptomatic and clear up without medical intervention within 6 to 12 months. Hence, most infected individuals are unaware of their diagnosis. There are no tests to find out a person’s “HPV status”, as there are so many different types of HPV (3). However, nucleic acid tests (such as this one) are available to accurately identify individuals who are infected with one of the 14 high-risk HPV strains. Detection of HPV nucleic acid (a positive test result) is indicative of an active HPV infection but does not mean that cervical dysplasia or cervical cancer is present.

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 (5).

How is HPV treated?
There is no treatment for HPV itself; however, there are treatments for the health problems associated with HPV. Genital warts can be treated with prescription medication, and cervical precancer can be effectively treated. Any cancers that are associated with HPV are more treatable when diagnosed and treated early; hence the importance of routine screening (5).

References:
1. 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.
2. Cervical Cancer. WHO.
3. Genital HPV Infection – Fact Sheet. (2021, January). CDC.
4. 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.
5. Human Papillomavirus (HPV) Treatment and Care. (July 2021). CDC.

Related Tests

• Human Papillomavirus (HPV) High-Risk 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.

Related Tests

• Human Papillomavirus (HPV) High-Risk Test