HPV (human papillomavirus) is a very common virus spread through sexual contact and skin-to-skin contact in the genital area. Most sexually active people encounter HPV at some point in their lives. The infection usually causes no symptoms, and most infections are cleared by the immune system within two years.
There are many types of HPV. Low-risk types can cause genital warts. If an infection with a high-risk type persists for a long time, precancerous changes can develop in the cervix; if left untreated, these changes may progress to cancer over the years. Almost all cervical cancers are linked to high-risk HPV types.
What does an HPV test show?
An HPV test shows whether high-risk HPV types are present in a sample taken from the cervix. Some tests also identify which of the types with the highest cancer risk, such as HPV 16 and HPV 18, are present (genotyping). The sample is taken in the same way as for a Pap smear; how this is done is described on the Pap Smear Test page.
A positive HPV test does not mean cancer; it only shows that a high-risk HPV type is present. A positive test also does not show when or from whom the infection was acquired.
Who is tested?
In the Turkish Ministry of Health screening program, women aged 30 to 65 are offered an HPV test every five years. Before the age of 30, HPV infection is more common and most infections go away on their own. There is no recommended HPV screening test for men.
Next steps after a positive result
In the national program, the next steps are decided according to the HPV type found and the Pap smear result from the same sample:
- HPV 16 or 18 positive: referral to an obstetrician-gynecologist.
- Other high-risk types positive, abnormal Pap smear: referral to an obstetrician-gynecologist.
- Other high-risk types positive, normal Pap smear: the test is repeated after one year. If HPV is positive again, referral to a specialist follows; if it is negative, screening every five years resumes.
Colposcopy is usually performed at the specialist assessment; how it is done and what follows are described on the Colposcopy page. International guidelines also base the decision not only on the latest test but also on previous test results, past treatment and age. It is therefore helpful to bring previous screening results to the assessment.
Is there a treatment for HPV?
There is no medicine that eliminates the HPV infection itself; what is treated are the cell changes and genital warts caused by the virus. Because most infections clear on their own, people with a positive test and no cell changes are followed with regular check-ups. Smoking is among the factors that increase the risk of HPV-related changes progressing to cancer; stopping smoking is recommended.
HPV vaccine
The HPV vaccine aims to prevent infection with the HPV types it covers. The greatest protection is achieved when it is given before exposure to HPV, that is, before sexual activity begins; the World Health Organization considers vaccination of girls aged 9 to 14 a priority. At older ages, the benefit of the vaccine is assessed according to the person’s age and circumstances. The vaccine does not treat an existing infection or cell change and does not protect against all high-risk HPV types. For this reason, vaccinated people also continue screening.
Condoms lower the chance of HPV transmission; however, they do not provide complete protection, because HPV can be transmitted from skin areas they do not cover.
Limitations
An HPV test shows the presence of the virus, not cell changes in the cervix. Most positive results belong to infections that will clear on their own; this can lead to further tests and anxiety. A negative test does not mean that a new infection will not occur in the future. No screening test detects every change; if there are complaints, an examination is needed regardless of the test result.