HPV Testing

The Human Papilloma Virus (HPV) was first linked to cervical cancer in the 1970’s. Women who are HPV positive have a more than 150 times greater risk of developing cervical cancer than those who are HPV negative. According to American Cancer Society estimates, 12,700 new cases of cervical cancer were diagnosed in 2011 and one third will die from their disease.There are more than 150 subtypes of the HPV virus, which are subdivided, in low risk and high-risk groups. Low risk strains are more often associated genital warts. High-risk strains can insert itself into the cell DNA to affect cell regulation and are most often associated with cervical cancer. HPV types 16 and 18 are the 2 most aggressive strains identified so far, with about 60 % of cervical squamous cell cancers associated with HPV 16 and 75% of cervical adenocarcinomas associated with HPV 18.

Over 4 billion cases of HPV are diagnosed in the U.S. each year and it is estimated that about 80 % of the population will be infected at some point, but the infections are usually TRANSIENT. Of those infected, 80-90% will be free of the virus within 2 years; although those infected with HPV 16/18 may only have a 70 % chance of clearing the virus which is still good odds.

The ability to test for HPV at the time of Pap smear has been a great benefit in reducing the risk of cervical cancer, by identifying those at greatest risk of developing the disease, while sparing those at low risk of unnecessary testing. Cervical screening with BOTH Pap smear and HPV has also been shown to decrease the risk of false negatives in women age 30 and older. In women age 21-29, testing for HPV is recommended only when the Pap smear is abnormal, as it is assumed that 80% of these women will be HPV positive (and that most will clear). We now also have the ability to further subtype high risk HPV to whether they are 16 and/or 18 positive, which has further helped our ability to triage those patients that need to go on to colposcopy and biopsy. Please keep in mind that we do not treat the HPV virus, but we treat the precancer and cancer that may occur in these patients. HPV testing is used as a triage tool in those with atypical Pap smears and a prognostic indicator for progression to high-grade cervical lesions.

So how does this information apply to specific treatment guideline?

Women ages 21-29:

  • Pap smear: normal; HPV testing not done > > repeat Pap smear in 2 years
  • Pap smear: Atypical cells (ASCUS); HPV negative >> repeat Pap smear in 1 year
  • Pap smear: ASCUS; high risk HPV positive >> schedule colposcopy
  • Pap smear: dysplasia or worse>> schedule colposcopy

Women > age 30:

  • Pap smear: normal; HPV negative>> repeat Pap smear in 3 years
  • Pap smear normal; HPV positive >> test for HPV 16/18; if positive schedule colposcopy, if negative repeat Pap in 12 months
  • Pap smear: Atypical cells (ASCUS); HPV negative >> repeat Pap smear in 1 year
  • Pap smear: ASCUS; high risk HPV positive>> schedule colposcopy.
  • Pap smear: dysplasia or worse>> schedule colposcopy

Keep in mind that these are just guidelines and individual factors can always influence recommendations. This is also an area of active research, so guidelines change as new data becomes available. Here at Peachtree Gynecology we can always advise you about the latest recommendations and offer the most advanced screening technologist and treatment options.