For women younger than 30 years of age, the Pap smear and pelvic exam are the primary cervical cancer screening tools. If results indicate abnormal changes that may be due to a high-risk type of HPV, then DNA HPV testing may be ordered as a follow-up test. It is not routinely used as a screening tool in this age group because HPV is very common and rarely causes cancer in those under 30.

The American College of Obstetricians and Gynecologists (ACOG) released guidelines in August 2003 recommending that women 30 years or older be offered the HPV DNA test in addition to their Pap smear and pelvic exam. If the HPV DNA test and Pap smear are negative and the woman does not have an underlying health condition, such as HIV or immunosuppression, then the guidelines suggest that she may wait three years before having another Pap smear and HPV DNA test.

The HPV DNA test and Pap smear may be ordered on a more frequent basis to monitor positive HPV tests, abnormal Pap smear changes, and those patients who have underlying medical conditions, such as HIV or immunosuppression.

During an exam, a doctor can detect warts and other lesions through visual inspection that may warrant further investigation. Some otherwise invisible warts in the genital tissue may be identified by applying acetic acid to areas of suspected infection. This process makes the infected areas whiten when they are examined by a procedure called colposcopy.

A doctor might also take a small piece of tissue (called a biopsy) from the cervix and examine it under a microscope. When either the Pap smear or the biopsy indicates a condition that could lead to cancer in some women (called intraepithelial neoplasia), the DNA HPV test can determine if the patient is infected with a high-risk strain of HPV that increases the chance that cancer might develop if not treated.

Women who are sexually active with more than one partner—or whose partner has more than one sex partner—should have regular exams for sexually transmitted diseases, including HPV. The American Cancer Society recommends that women over the age of 18 and all sexually active women have a Pap smear yearly to screen for cancer or situations that may develop into cancer. When results indicate abnormal changes that may be due to a high-risk type of HPV, then DNA HPV testing may be ordered as a follow-up test.

Doctors may order the HPV DNA test as a cervical cancer screening test, along with the Pap smear test, when a woman is 30 years old or older and at intervals of 3 years if initial testing is negative. Patients who are positive for high-risk HPV, have abnormal cell changes on their Pap smear, or have underlying medical conditions should be screened more frequently, with the frequency to be determined by the patient and their doctor on an individual basis.

See Screening: Cervical Cancer (ages 18-29), (ages 30-49), (ages 50 and up)

Some doctors will test men who fall into a high-risk category. Men who have sex with men and those who have HIV may be tested for HPV. Evaluating the risk of HPV-related diseases of the anal canal in men is becoming more common.

On a Pap smear, “low-grade” changes indicate the likely presence of HPV and the need for further testing. A positive HPV DNA test indicates the presence of a high-risk type of HPV, but the test does not specify which type is present. If both are negative, it is unlikely that there is a high-risk HPV infection. If the Pap smear is abnormal but the HPV DNA test is negative, then follow-up testing and further monitoring are indicated.

Typing of the HPV is not usually necessary. However, if it is done, then common findings may include:

HPV types 6 and 11 typically cause venereal warts, and (along with types 42, 43, and 44) have a low risk of progressing to cancer.

HPV types 16, 18, 31, 33, and 39 have a higher risk of progressing to cancer.

Recently, some doctors have screened men who are at a high risk for sexually transmitted diseases for HPV-related anal cancer. The test is similar to a cervical Pap smear where the anal lining is swabbed and the cells are examined under a microscope. HPV DNA tests can also be performed on these samples. As in cervical samples, positive results will need to be followed up by your doctor with further testing, including a more thorough exam and possible biopsy.

HPV is one of the most commonly transmitted STDs in the world. In 90% of women who have cervical HPV infection, the infection becomes undetectable within two years. A few women have persistent infection, which is a key risk factor for cervical cancer. Regular Pap smears and HPV screening can monitor this risk and provide an early warning that you might need treatment.