The Human Papillomavirus (HPV) is an extremely common group of sexually transmitted viruses. While many infections resolve spontaneously, persistent infection with high-risk types is the nearly universal cause of cervical cancer. The HPV DNA test is a powerful screening tool that has revolutionized early detection and prevention. By identifying the virus’s genetic material, the test allows healthcare providers to monitor high-risk individuals and intervene before cancer develops, offering the best chance for successful management.
What HPV DNA Testing Is and How It Works
The HPV DNA test is a molecular diagnostic tool designed to detect the genetic material (DNA) of high-risk HPV types in cervical cells. This differs from the traditional Pap test, which relies on cytology—the microscopic examination of cells for abnormal changes. The DNA test identifies the infectious agent itself, rather than waiting for the biological damage it might cause.
The test specifically targets the 14 types of HPV considered high-risk, including types 16 and 18, which account for approximately 70% of all cervical cancer cases. Sample collection is performed similarly to a standard Pap test during a pelvic exam, using a brush or spatula to collect cells from the cervix.
The HPV DNA test is used either as a primary screening tool or as part of co-testing. Primary screening uses only the DNA test, initiating further steps if the result is positive. Co-testing involves performing the HPV DNA test and the Pap test simultaneously. The increased sensitivity of the HPV DNA test has made primary screening the preferred method in many current guidelines.
Current Screening Schedules and Recommendations
Cervical cancer screening guidelines have shifted toward primary HPV testing and a later starting age. Major health organizations now recommend that individuals with a cervix begin screening at age 25. This change reflects a better understanding of HPV’s natural history, as infections in younger people are common but typically clear up spontaneously without causing disease.
For individuals aged 25 to 65, the preferred screening protocol is primary HPV testing every 5 years. This longer interval is possible because a negative HPV DNA test provides strong assurance of low risk for developing cervical cancer. Persistent infection is required for precancerous changes to develop, making HPV testing the focus during this age range.
If primary HPV testing is unavailable, acceptable alternatives include co-testing (Pap test and HPV DNA test combined) every 5 years. Screening with a Pap test alone remains an option, but requires a shorter interval, typically every 3 years. Individuals vaccinated against HPV should still follow these same age-based screening schedules.
Screening can generally be discontinued after age 65 if the individual has a documented history of regular, negative screening results over the previous decade. This includes at least two consecutive negative HPV tests or co-tests within that timeframe. Conversely, those with a history of high-grade precancerous lesions must continue surveillance for at least 25 years, even past age 65.
Interpreting Results and Follow-Up Care
HPV DNA test results are reported as either negative or positive for high-risk HPV. A negative result means no high-risk HPV DNA was detected, indicating a very low risk of developing cervical cancer in the next five years. A positive result signals the presence of high-risk HPV DNA, but it does not mean cancer is present.
A positive result signals an elevated risk and the need for closer monitoring or further evaluation. The laboratory often performs genotyping to identify if the infection is specifically due to the highest-risk types, HPV 16 or HPV 18. If the result is positive for either HPV 16 or 18, the patient is typically referred directly for a colposcopy due to the highest risk level.
If the test is positive for other high-risk types but negative for 16 and 18, the next step depends on the accompanying Pap test result. If the Pap test is normal, the provider often recommends active surveillance, repeating the co-test in one year. Many HPV infections are transient and resolve naturally, but persistent infections require more intensive follow-up, potentially leading to a colposcopy.