HPV DNA test
Human papilloma virus - testing; Abnormal Pap smear - HPV testing; LSIL-HPV testing; Low-grade dysplasia - HPV testing; HSIL - HPV testing; High-grade dysplasia - HPV testing; HPV testing in women; Cervical cancer - HPV DNA test; Cancer of cervix - HPV DNA test
The HPV test is used to check for infection with HPV types associated with cervical cancer. Typically, the test looks for 14 different HPV types. HPV type 16 and HPV type 18 are most closely associated with cervical cancer.
If you're a woman 21 or over, it's important to begin getting regular pelvic examinations to take charge of your health. An important part of this pelvic exam may include a test, called a Pap smear, to detect the often life-threatening disease, cervical cancer, even before it starts. And here's the key, cervical cells become abnormal years before they turn to cancer. That gives an excellent window of opportunity. So, what is a Pap smear? A Pap smear is a microscopic examination of cells scraped from the opening of the cervix. The cervix is the lower part of the uterus, or womb, that opens at the top of the vagina. The test looks for cervical cancer or abnormal cells. Most cervical cancers can be found, and treated early, or even before they start, if women have routine Pap smears and pelvic examinations. For this test, you will lie on a table and place your feet in stirrups. The doctor will insert an instrument called a speculum into the vagina and open it slightly to see inside the vaginal canal. Cells are gently scraped from the cervix area, and sent to a lab for examination. When a Pap smear shows abnormal changes, you will need further testing. The next step depends on the results of the Pap smear, and on your previous history of Pap smears, and risk factors you may have for cervical cancer. You may need a biopsy using a light and a low-powered microscope, called colposcopy. You may also need a test to check for infection with human papilloma virus, or HPV, which can cause cervical cancer. If you are diagnosed with cervical cancer, the doctor will order more tests to determine how you should be treated, and how far the cancer has spread. This is called staging. Treatment will depend on the stage of the cancer, the size and shape of the tumor, your age and general health, and your desire to have children in the future. Early cervical cancer can be treated with surgery to remove the abnormal tissue, or freeze abnormal cells, or burn abnormal tissue. Treatment for more advanced cervical cancer may include radical hysterectomy, removal of the uterus and much of the surrounding tissue, including lymph nodes and the upper part of the vagina. Radiation may be used to treat cancer that has spread beyond the pelvis, or if cancer returns. The woman may also have chemotherapy to kill the cancer if the cervical cancer's advanced. The Pap smear test is not 100% accurate and cervical cancer may be missed in a small number of cases. Fortunately, cervical cancer develops very slowly in most women and follow-up Pap smears should identify worrisome changes in plenty of time for treatment. Make sure your doctor knows about all the medicines you are taking. Some, including estrogen and progestins, may affect the result of your Pap smear. Pap smears can be a wonderful, life saving tool.
How the Test Is Performed
The HPV test may be done during a Pap test. If they are done together, it is called "co-testing."
You lie on a table and place your feet in footrests. Your health care provider inserts an instrument (called a speculum) into the vagina to open it slightly. This allows the provider to see the cervix. Cells are gently collected from the cervix area. The cervix is the lower part of the womb (uterus) that opens at the top of the vagina. The sample of cells is sent to a lab for examination.
How to Prepare for the Test
No special preparation is required for an HPV test. If you're getting a Pap test at the same time, it is recommended that you do NOT do the following in the 24 hours before the test:
- Douche (douching should never be done)
- Have intercourse
- Use tampons
For your comfort, you may want to empty your bladder just before the test.
How the Test will Feel
The exam may cause some discomfort. Some people say it feels like menstrual cramps.
You may also feel some pressure during the exam.
You may bleed a bit after the test.
Why the Test Is Performed
High-risk types of HPV can lead to cervical cancer. The HPV test is done to determine if you are infected with one of these high-risk types.
Your provider may order an HPV test:
- If you have a certain type of abnormal Pap test result.
- Along with a Pap smear to screen people age 30 and older for cervical cancer.
- Instead of a Pap smear to screen people age 30 and older for cervical cancer. (Note: Some experts suggest this approach for those age 25 and older.)
The HPV test results help your provider decide if further testing or treatment is needed.
Normal Results
A normal result means you do not have a high-risk type of HPV. You may be asked to return in 3 or 5 years for repeat testing.
What Abnormal Results Mean
An abnormal result means you have one or more high-risk types of HPV.
If HPV types 16 or 18 are detected, your provider will likely recommend colposcopy. This is a procedure in which the cervix is magnified with a binocular-like instrument. Small biopsies (tissue samples) are often taken during this procedure to look for evidence of a precancerous change or cancer.
If the test is positive for one or more of the other high-risk HPV types, repeat testing in one year may be recommended. Your provider will advise you about next steps if your test is positive.
References
Fontham ETH, Wolf AMD, Church TR, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. 2020 Sep;70(5):321-346. Epub 2020 Jul 30. PMID: 32729638
Perkins RB, Guido RS, Castle PE, et al. 2019 ASCCP Risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2020;24(2):102-131. PMID: 32243307
Salcedo MP, Phoolcharoen N, Schmeler KM. Intraepithelial neoplasia of the lower genital tract (cervix, vagina, vulva): Etiology, screening, diagnosis, management. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 29.
US Preventive Services Task Force website. Cervical cancer: Screening.
Wang ZX, Peiper SC. HPV detection techniques. In: Bibbo M, Wilbur DC, eds. Comprehensive Cytopathology. 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 38.
Version Info
Last reviewed on: 10/15/2024
Reviewed by: John D. Jacobson, MD, Professor Emeritus, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
