HPV is a common virus that can cause cervical cancer. While most HPV infections go away on their own, persistent infections with high-risk HPV types like HPV 16 and HPV 18 can lead to cervical cell changes and cancer. HPV testing and genotyping can help determine which infections persist and guide screening and treatment, but are not needed for all women. HPV vaccination is still recommended even if a woman has been exposed to or infected with HPV.

1. HPV Testing and Genotyping
What, Why, When
© June 2011

2. What is HPV?
• HPV is a virus that likes to attack cells
on or near the skin and other surfaces in
the body
• The full name of this virus is Human
Papillomavirus
• HPV is very common. About 80% of
women will get it in their lifetime. Most of
these infections will go away.
• There are over 100 different types of
HPV.
• Different types cause different diseases,
like plantar and skin warts, genital warts,
& cancers in the genital region such as
cervical cancer.

3. How is HPV linked to Cervical
Cancer?
• Over a dozen different HPV types have
been shown to have the potential to
cause cervical cancer, as well as vulvar,
vaginal, and anal cancer.
• Most HPV infections will clear up on their
own, probably without you even knowing
you have HPV.
• Most HPV types do not cause cancer, but
some types might put you at risk. These
‘high risk’ types are the ones we want to
follow more closely.
• This presentation provides information on
the tests that can help you and your
provider keep tabs on any high risk
infection.

4. What does HPV do to the cervix?
• If a high risk HPV infection does not clear
on its own, it is called a persistent HPV
infection.
• Sometimes persistent HPV infections can
lead to changes in the cells on the cervix.
Usually, these cervical changes happen
slowly, over a period of years.
• These cell changes can be treated if they
are detected early. But if they are not
treated, the infection can grow and
become cervical cancer.
• There are a number of ways to treat these
early cervical changes. Talk to your
healthcare provider about best treatment
options for you.
Normal cervix

5. How do I find out if I have a
persistent HPV infection?
Several different tests screen for HPV infection
• The Pap Test tells when there are changes in the
cells of the cervix. This test has been used in the
US for over 50 years. During this time period, there
has been more than a 70% reduction in cervical
cancer deaths in the US and other industrialized
countries using Pap tests for routine screening.
• HPV Tests - New tests are now available to help
us learn which HPV infections to treat and which
we can watch to see if they clear up on their own.
– An HPV test can determine if you have a high
risk HPV infection
– An HPV genotyping test can determine which
HPV types you are infected with
Dr. Georgios Papanicolaou
Inventor of the Pap test

6. How is a Pap test done?
There are two methods for Pap tests.
• One method involves brushing the cervix
with a spatula and broom, and then
‘smearing’ what is collected on a slide.
• The second and more commonly used
method in the U.S. today involves
collecting a specimen with the spatula
and broom, and then putting it into a
liquid that can be plated onto a slide.

7. How is an HPV test done?
An HPV test (also known as an HPV DNA test) can discover if you have
been infected with specific high risk or cancer-causing HPV types.
• In some women, infection with these high risk HPV
types can lead to an abnormal Pap test and, if left
untreated, to cervical cancer.
• The remaining liquid from the Pap test can be
tested for a number of additional things, including HPV.

8. Why would I get an HPV test?
Colposcopee
• If your Pap test is borderline abnormal, or considered
to be of “undetermined significance” (ASCUS), then
an HPV test can help decide if you may benefit from
taking a closer look at your cervix with a magnifying
scope, which is known as a‘colposcope’
• If you are 30 years of age or older, an HPV test may
be used in conjunction with a Pap test. The HPV test
can determine whether additional testing, such as
colposcopy, may help to find abnormal cells.
• If you have had a cervical procedure like a LEEP or
cone biopsy, an HPV test might provide additional
information to guide the management of your cervical
cancer screening after you have the procedure.

9. What is HPV genotyping?
• The standard HPV test only tells us if a woman has
an HPV infection, not which type or types of HPV
are causing the infection.
 For instance, if a women has HPV 16 or HPV 18, her HPV
test would return only a ‘positive’ result.
• HPV genotyping (also known as HPV typing)
has recently become available for clinical use. An
HPV genotyping test can identify the specific HPV
type, not just test for the presence of any type.
 For instance, if a woman has HPV 16 or HPV 18, her HPV
typing test would return a result of ‘HPV 16’ or ‘HPV 18’
• Like the HPV test, this test is often taken from the
same sample as the Pap test or by an additional
gentle swab of your cervix at the time of a Pap test
and performed by a healthcare provider in the
office.
Cervical Cancer.
Photo courtesy of Thomas C.
Wright, Columbia University

10. Why would my provider recommend
that I have HPV genotyping?
• It is now known that infection with HPV 16,
HPV 18, and some other HPV types carry a
higher risk of causing cancer than
infections with other HPV types.
• HPV genotyping can be used in some
cases to gain a better understanding of a
woman’s risk of developing cancer. With
HPV typing information, it is possible for
you and your healthcare provider to make
better decisions about your plan for follow-
up screening and further testing.

11. When would my provider recommend
that I have HPV genotyping?
If you have:
• Normal Pap smear and positive high
risk HPV test there are two options:
1. Wait a year and repeat both
tests. If the high risk HPV test is
still positive, your provider might
recommend a colposcopy.
2. Perform HPV genotyping for
HPV 16 or 18 now. If the HPV
genotyping test is positive for
HPV 16 or 18, your provider
might recommend a colposcopy.
If the HPV genotyping test is
negative for HPV 16 and 18,
you can wait 12 months and
then repeat a Pap test and HPV
test (NOT genotyping).

12. Why would my provider recommend that I
NOT have HPV testing or genotyping?
These tests are not for everyone. HPV
testing and HPV genotyping are
recommended for very few women. There
are a number of reasons.
• For most Pap abnormalities, HPV
testing or HPV genotyping is not
useful for informing follow-up or further
testing.
• If your Pap test shows a true pre-
cancerous abnormality, then you can
assume your HPV test would be
positive because nearly all cases of
pre-cancerous and cancerous lesions
are associated with HPV. There would
be no need for any HPV test because
it adds no new information.

13. When would my provider offer an HPV test
or HPV genotyping at the time of a Pap test?
• If you are 30 or over, your
healthcare provider might want to
perform an HPV test at the time of a
Pap test. If the HPV test is negative
and the Pap test is normal, you
might not need to repeat either for
years.
• If you have a normal Pap test and
are HPV positive, your provider
might want to consider HPV
genotyping to help decide whether
you need further testing.

14. Why don't I get HPV genotyping
before vaccination?
No professional medical or scientific
organization recommends HPV testing,
either HPV DNA or HPV genotyping testing,
prior to getting vaccination. There are a
number of reasons:
1) The test is unnecessary. Whether the
test results are positive or negative for
HPV, women in the recommended age
groups should still get vaccinated.
2) Requiring the HPV test creates barriers
to vaccination. Requiring women to get
an HPV test prior to vaccination only
adds another barrier that includes an
extra visit, extra exam, and an extra cost
to getting vaccinated.

15. What if I have a ‘positive’ HPV test or an
abnormal Pap test before vaccination?
• The likelihood is that you have not
been exposed to all the HPV types
found in the currently available
vaccines.
• If you were exposed to one of the
types against which an HPV vaccine
protects, the vaccines may still protect
you against other HPV types.
• While an HPV vaccine might not work
as well for you as for someone who
had not been exposed to the HPV
types for which the vaccines are
designed, it is likely that you will still
get some protection from vaccination.

16. What if I have a ‘negative’ HPV test
before vaccination?
There are two cases in which you might
receive a ‘negative’ HPV test. In either case,
vaccination will provide benefit to you.
• If you are a woman who has not been
exposed to high risk HPV types, the
vaccines will work very well for you.
• If you are a woman who has been
exposed to high risk HPV types, but
cleared them on your own, your body’s
natural defenses probably protect you
well from HPV.
– Vaccines may be helpful in
boosting your bodies natural
defenses or protecting you from
other HPV types

17. HPV Testing and Genotyping
Summary
• HPV is very common.
• Most infections will go away on their own as a result of your
body’s immune system getting rid of them.
• HPV testing and HPV genotyping can be very useful in informing
you and your provider about the best timing and frequency for
cervical cancer screening.
• HPV testing and genotyping are NOT for everyone.
• If you have precancerous cervical changes, you can assume you
have been infected with a high risk HPV. Testing for HPV will not
change the management of your HPV infection.
• HPV testing is not recommended prior to vaccination against
HPV.