HPV Testing – Is It for Me?

What is HPV?

HPV, human papillomavirus, is an infection that is passed from one person to another through direct skin-to-skin contact. When genital skin (on the penis, scrotum, vulva [area near the opening to the vagina] and near the anus [rectal opening]) is involved, the infection is called “sexually-transmitted”.

There are about 100 different types of HPV. Most HPV infections do not cause any health effects at all because the infected person’s immune system gets rid of them before they can do any damage. At times certain types of HPV (“low risk”) can cause minor changes. Usually those types do not cause long term problems. But other types (“high risk”) can cause infected cells to lose control of their own growth; if early changes are not found and treated, these changes can turn into cancer years later.

Why is this important for women’s health?

HPV infection is very common. One of the sites most often infected by HPV is the genital tract. Several studies have shown that young sexually active women become infected with HPV in the genital area at the rate of 15-20% per year. When followed for three years, about 80% of women in those studies tested positive for HPV at one time or another.

When certain “low risk” types of HPV infect the outer genital skin (vulva) or cervix, they can cause genital warts (also known as condylomata acuminata) and harmless changes on the cervix. Other “high risk” types commonly infect the cervix where they can cause changes that might become cancer in the future ( dysplasia), depending on the type of HPV and the length of time the infection has lasted. If high-risk HPV infections on the cervix are not found and not treated for years, some of those infections can result in cervical cancer.  Over 4000 women die each year in the US from cervical cancer.

How is HPV infection spread?

Vaginal, oral and anal sex can all spread HPV. Many persons who have HPV do not know they have it – they can spread it to their sexual partners without knowing it. Most people who become infected with HPV have gotten it from a partner who had no symptoms at all.

How would I know if I had HPV?

Often infected women and men do not know that that they have an HPV infection. Some persons develop genital warts or condylomata acuminata which are small, raised, skin-colored or gray rough-surfaced bumps ranging from the size of sesame seeds to the size of apple seeds or even larger. They usually don’t hurt, but they may itch slightly or feel irritated. Your clinician can identify these lesions during an exam. Other persons develop HPV infections of the cervix (the lower part of the uterus, located at the top of the vagina). These infections do not produce symptoms that patients can see or feel. The only way to know about an HPV infection of the cervix is to have a Pap test or cervical HPV test performed during a pelvic exam. A Pap showing dysplasia or intraepithelial neoplasia or cervical cancer almost always is a result of
HPV infection.

What is a Pap test?

In this test, cells are scraped off the cervix and placed on a slide. A specially trained laboratory professional examines the slide and looks for abnormal cells. If abnormal cells are found, the slide is further reviewed by a pathologist. The Pap test report gives useful and important information to the clinician, helping him or her decide whether further testing is necessary if the results are abnormal.

What is an HPV test?

The HPV test is performed either from the same specimen as a Pap test, or from a separate brush sample from the cervix. It detects HPV genetic material (DNA) from the 13 types of HPV that can most commonly be associated with the development of cervical cancer. These are the “high risk” types. Most people who are infected with these types of HPV may never have any related problems. However, women who have a high-risk type of HPV are much more likely than uninfected women to develop a cervical pre-cancer (dysplasia) or cancer over time.

Which test should I get: an HPV test or a Pap test?

The most important test for every sexually-active woman to have regularly is the Pap test. If her Pap is abnormal, further testing can be done to determine the exact location and nature of the abnormality and to treat it. Early detection and treatment are highly successful at preventing cervical cancer.

Then who should get an HPV test?

The HPV test is helpful in women whose Pap test report is “ atypical squamous cells of undetermined significance”, often abbreviated as “ASC-US”. This means that the result is uncertain – it is not normal but it is also not abnormal in any precisely defined way. Some of these Pap tests with uncertain results show HPV infection on additional testing. So the HPV test can help your clinician understand the reason for the uncertain Pap. In addition, most experts believe that for women over 30, HPV testing along with a routine Pap test is the best way to screen for dysplasia or cervical cancer. This combination of testing is so reliable that if both tests are normal, the tests should be repeated only every three years.

In addition, an HPV test may be recommended as part of follow-up after an abnormal Pap test has been evaluated and possibly treated.

Why not test women under 30 for HPV with their Pap test?

HPV is so common and so unlikely to cause problems in young women that finding it isnot helpful. On the other hand, the Pap test does find cell changes thatare important to evaluate.

What if my test is negative?

A woman whose HPV DNA test is negative has only a small chance of having dysplasia or cancer at the time of the test. But she should continue to obtain regular Pap tests to detect any hidden or future infection.

What happens if my HPV test shows that I have HPV?

If you have a positive HPV test and an abnormal Pap, you will most likely be advised to undergo colposcopy. This is a procedure in which the cervix is examined using a bright light and magnification. Often a biopsy (a small pea-sized piece of tissue) is taken and sent to a pathology lab for examination. The biopsy is the most reliable test and the results of the biopsy, not the Pap or the HPV test, are used in planning the most appropriate treatment, if any.  If you have a positive HPV test and a normal Pap test, your healthcare provider will make a personal recommendation for you based on your own individual health circumstances and your past Pap and HPV history.

Copyright © 2003, 2008 ASCCP. All Rights Reserved.
These materials were developed by the American Society for Colposcopy and Cervical Pathology (ASCCP) Patient Education Committees and approved by the Board of Directors for use by patients.

This material is provided for informational purposes only. It does not constitute medical advice and is not intended to replace professional care. Please consult your health care provider with any questions or concerns you may have regarding your condition. The ASCCP National Office does not provide individual consultation on cases or diagnoses.

While you may download, print and distribute these materials freely, they are copyrighted materials and all rights are owned by ASCCP. Therefore, they may not be changed, edited or altered in any way.

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Author: H. Sandra Chevalier-Batik

I started the Inconvenient Woman Blog in 2007, and am the product of a long line of inconvenient women. The matriarchal line is French-Canadian, Roman Catholic, with a very feisty Irish great-grandmother thrown in for sheer bloody mindedness. I am a research analyst and author who has made her living studying technical data, and developing articles, training materials, books and web content. Tracking through statistical data, and oblique cross-references to find the relevant connections that identifies a problem, or explains a path of action, is my passion. I love clearly delineating the magic questions of knowledge: Who, What, Why, When, Where and for How Much, Paid to Whom. My life lessons: listen carefully, question with boldness, and personally verify the answers. I look at America through the appreciative eyes of an immigrant, and an amateur historian; the popular and political culture is a ceaseless fascination. I have no impressive initials after my name. I’m merely an observer and a chronicler, an inconvenient woman who asks questions, and sometimes encourages others to look at things differently.