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HPV testing guidelines: here’s what you need to know

Medically reviewed by Neka Miller, PhD on March 15, 2021. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

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HPV, or human papillomavirus, is the most common virus that can lead to certain types of cancer. While anyone who is sexually active can contract it, some people are at a higher risk than others. That’s why it's important to be aware of the recommended guidelines for HPV testing. Read on for the most up-to-date HPV testing guidelines for various age groups.

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HPV Testing: What It Is and Why It’s Important

Before we dive into the recommended screening guidelines, let’s first dissect what HPV testing is for and why it’s so important.

An HPV test screens for human papillomavirus (HPV), which is a sexually transmitted infection (STI) that—depending on the HPV strain—can increase the risk of cervical cancer. The majority of HPV types are not associated with cervical cancer risk and are commonly eliminated from the body over time without any medical intervention. However, certain strains of HPV—appropriately named “high-risk” HPV strains (or genotypes)—are significant risk factors for cervical and other types of cancer.
Cervical cancer is often preventable if it's caught at an early stage, which is why routine HPV testing and/or Pap smears is important: it offers a chance to understand if you are at a higher risk of cervical cancer so you can seek treatment early to protect your health.

What’s the Difference Between HPV Testing and a Pap Smear?

While HPV tests and Pap smears are done with the same goal in mind (determining if someone is at an especially high risk of cervical cancer), they test for different things. A Pap test looks for abnormal cells that can lead to cancer in the cervix, while an HPV test looks for molecular traces of human papillomavirus (HPV) in the body.

One other major difference between HPV testing and Pap smears? HPV testing is possible using self-collected vaginal samples (using a vaginal swab) that can then be sent to a laboratory for analysis. That’s how the Everlywell at-home HPV Test works, for example.

On the other hand, as part of the Pap smear process you can expect the following:

  • You may be asked to undress from the waist down or entirely.
  • You will lie on an exam table and place your heels in holders called stirrups.
  • Your physician will gently insert a speculum, an instrument that holds the vaginal walls apart so the physician can easily see your cervix, into your vagina. While an uncomfortable sensation for some women, this process should not hurt.
  • Your physician will then use a brush or flat spatula device to collect a sample of cervical cells from your cervix that will be sent to a lab to test for abnormalities or the presence of cancer.

If you are scheduled to have a Pap smear in the next 2 days, here are some tips for how to prepare for your exam:

  • Avoid scheduling your test for a time when you are menstruating
  • Avoid rinsing your vagina with water or another fluid
  • Avoid using a tampon
  • Avoid having sex
  • Avoid using a birth control foam, cream, or jelly
  • Do not use a medicine or cream in your vagina

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What Are the Current Guidelines for HPV Testing?

Here is a breakdown of the screening recommendations for both HPV testing and Pap smears.

The CDC recommends getting your first Pap smear at age 21. If your results are normal, your physician may tell you to wait 3 years until your next test. Follow their recommended testing cadence from age 21-29.

If you are age 35-65, talk to your healthcare provider about which testing option is right for you:

  • A Pap test only. If your result is normal, your healthcare provider may advise you to wait three years until your next Pap test.
  • An HPV test only. This is also called primary HPV testing. If your result is normal, your healthcare provider may suggest waiting five years until your next screening test.
  • An HPV test and Pap smear (co-testing). If both of your results are normal, your healthcare provider may tell you that you can wait five years until your next screening.

Are HPV Tests Accurate?

The results from your HPV test will come back as either positive or negative:

  • A positive test result means that you have a type of high-risk HPV that's linked to cervical cancer. This does not mean that you have cervical cancer now, but that cervical cancer could develop in the future.
  • A negative test result means that you likely aren’t infected with high-risk HPV strains that can lead to the development of cervical cancer.

As with any screening test, an HPV test carries the risk of false-positive or false-negative results, although this is rare.

Depending on your test results, your healthcare provider may recommend one of the following as a next step:

  • Normal monitoring. If your Pap smear and/or HPV test results are normal, continue to follow the recommended screening guidelines for your age.
  • Colposcopy. Your physician uses a special magnifying lens (colposcope) to more closely examine your cervix.
  • Biopsy. Your physician takes a sample of cervical cells (biopsy) to be examined more closely under a microscope.
  • Removal of abnormal cervical cells. This may prevent cancerous cells from developing.
  • Seeing a specialist. If your Pap test or HPV test results are abnormal, your physician may refer you to a gynecologist for a colposcopic exam.

The at-home HPV Test from Everlywell will, with greater than 99% accuracy, tell you if you are infected with a high-risk type of HPV (for 14 different genotypes) and whether or not that infection is due to HPV 16 or HPV 18/45.

Want to test for HPV without having to leave your home? Shop the Everlywell HPV Test to get an easy-to-use, at-home collection kit that includes everything you need for collecting a vaginal swab and sending it to a lab for HPV testing. You get your digital results in days and in the event that your test results are abnormal, you’ll have the opportunity to connect with our independent physician network at no additional cost to discuss your particular case.

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References

1. What Should I Know About Screening? Centers for Disease Control and Prevention. URL. Accessed March 15, 2021.

2. Cervical cancer. NHS UK. URL. Accessed March 15, 2021.

3. HPV test. Mayo Clinic. URL. Accessed March 15, 2021.

4. ACS’s Updated Cervical Cancer Screening Guidelines Explained. National Cancer Institute. URL. Accessed March 15, 2021.

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