HPV testing in women is done through a simple cervical sample, collected during a routine pelvic exam or, more recently, through an FDA-approved self-collection kit you can use at home. The test looks for DNA from high-risk strains of the human papillomavirus that can lead to cervical cancer. It’s different from a Pap smear, though both tests use a similar collection process and are often done at the same time.
HPV Test vs. Pap Smear
These two tests answer different questions. A Pap smear (also called a Pap test) examines cells from your cervix under a microscope to check for abnormal changes. It tells you whether something unusual is already happening in your cells. An HPV test, on the other hand, looks for DNA from the virus itself. It can tell you whether you have HPV and which type it is, including whether it’s a high-risk strain linked to cancer.
The distinction matters because HPV infection often comes first, sometimes years before any cell changes show up on a Pap. Two strains in particular, HPV 16 and HPV 18, cause about 70% of cervical cancers worldwide. Catching the virus early, before it triggers abnormal cells, gives you and your provider more time to monitor and act.
Your provider may order just one of these tests or both together (called co-testing), depending on your age and screening history.
What Happens During the Test
If you’re getting tested at a clinic, the process is the same whether you’re having a Pap, an HPV test, or both. You lie on an exam table and your provider inserts a speculum to open the vaginal walls and get a clear view of your cervix. Then they use a small brush or sampling tool to gently collect cells from the surface of the cervix. The whole collection takes about a minute.
Those cells go into a liquid and are sent to a lab. If you’re having both tests done, the same sample can usually be used for both. Occasionally, two separate samples are taken. You may feel brief pressure or mild discomfort during the swab, but it’s not painful for most people.
Self-Collection Kits
The FDA has approved HPV self-collection tests that you can use at home. These kits let you take your own vaginal swab and send it to a lab for analysis. Research shows the test is just as accurate as a sample collected in a provider’s office, according to the American Cancer Society. Self-collection is a meaningful option if you’ve been avoiding screening because of discomfort, access issues, or preference for privacy. The key requirement is that you use an FDA-approved test and collection device.
Self-collection tests screen for high-risk HPV strains only. They don’t replace a Pap smear. If your self-collected sample comes back positive, you’ll still need an in-office visit for further evaluation.
When and How Often to Get Tested
Current guidelines from the Women’s Preventive Services Initiative break screening into two age brackets:
- Ages 21 to 29: A Pap test every 3 years is recommended. HPV co-testing is not recommended for this age group because HPV infections are extremely common in younger women and usually clear on their own. Testing for HPV here would flag many infections that would never become dangerous, leading to unnecessary follow-ups.
- Ages 30 to 65: The preferred approach is a primary HPV test every 5 years. Alternatively, you can do co-testing (HPV plus Pap) every 5 years, or a Pap test alone every 3 years if HPV testing isn’t available.
Primary HPV testing, meaning an HPV test as the first and only screening step, is now considered the preferred strategy for women 30 and older. Clinical trials have found that it detects precancerous changes just as effectively as co-testing but requires fewer tests over a lifetime and causes fewer false alarms.
Women at average risk should not be screened more frequently than every 3 years. Screening typically stops at age 65 for women who have had adequate prior screening with normal results.
Insurance Coverage
Under the Affordable Care Act, all Marketplace health plans and many employer plans must cover cervical cancer screening, including Pap tests for women ages 21 to 65, with no copay, coinsurance, or deductible. This applies even if you haven’t met your yearly deductible. Check with your specific plan to confirm HPV testing is included, but in most cases routine cervical screening is fully covered as a preventive service.
What a Positive HPV Result Means
A positive HPV test means high-risk HPV DNA was found in your cervical cells. It does not mean you have cancer or precancer. Most HPV infections clear on their own within a year or two without causing any harm. What it does mean is that your provider needs to assess your individual risk and decide on a follow-up plan.
That plan is no longer one-size-fits-all. Updated guidelines take a more personalized approach, weighing your current result alongside your previous screening history, any past treatments for precancerous cervical changes, and your age. Based on that full picture, your provider may recommend one of several paths:
- Repeat testing in 1 or 3 years: If your overall risk is low, you may simply come back for another HPV test or co-test sooner than the usual 5-year interval.
- Colposcopy and biopsy: If your risk is higher, your provider may want a closer look at your cervix using a magnifying instrument called a colposcope. During this procedure, they may take a small tissue sample to examine under a microscope.
- Treatment: If precancerous cells are confirmed through biopsy, treatment removes or destroys the abnormal tissue before it can progress.
The specific HPV type matters here too. A positive result for HPV 16 or 18 generally prompts a more immediate follow-up than a positive result for other high-risk types, because these two strains carry the greatest cancer risk.
What HPV Testing Cannot Do
Standard HPV screening tests for women focus on the cervix. There is no routine, FDA-approved screening test for HPV in other parts of the body, such as the throat or anus, even though HPV can cause cancers in those areas. There’s also no blood test for HPV. The only way to detect it is by sampling cells from the area in question.
HPV tests also don’t tell you when you were infected or who transmitted the virus. HPV can remain dormant for years, so a positive result doesn’t necessarily reflect recent sexual contact. A negative result means no high-risk HPV was detected at the time of the test, but it doesn’t guarantee lifetime protection since new exposures can happen.