Plastic vaginal speculum used for HPV screening via pap smear test

HPV screening: guidelines, why it’s important, and how to overcome barriers to testing

Medically reviewed on April 26, 2023 by Morgan Spicer, Medical Communications Manager. 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.

Table of contents

What is HPV?

Human papillomavirus, or HPV, is a virus that commonly leads to growth or warts on the skin or the body’s mucous membranes.[1] There are more than 150 varieties of HPV, and although many result in no symptoms or warts on the body or genitals, there are some kinds of HPV that can result in cancer.[2]

HPV infections can be acquired by skin-to-skin contact or by sexual intercourse. In fact, HPV is estimated to be the most common sexually transmitted infection, or STI.[3] Most infections are asymptomatic, and around 90% of HPV infections are cleared by the body within two years, but there is no cure for HPV, and the infections that persist can result in developing cancer [3]. Nearly all cervical cancers are associated with HPV infections–with around 94% of cervical cancers being linked to HPV subtypes 16, 18, and 45–-but HPV infections are also associated with certain oropharyngeal (throat), rectal, anal, vaginal, vulvar, and penile cancers. [1, 4].

Test for HPV

What are the symptoms of HPV?

Most cases of HPV infection have no symptoms at all, and are naturally cleared by the body in two years. In those who do show symptoms, HPV normally manifests as papillomas, or warts, on the body.[1] These can include common or plantar warts on the hands, feet, or other areas of the body, or genital warts. Warts often appear as hard, raised or bumpy lesions on the skin. HPV can be spread by skin-to-skin contact, or by contact with contaminated surfaces.

How can you test for HPV?

HPV is divided into low-risk and high-risk strains. The strains that are responsible for causing warts on the body and genitals are usually considered low-risk and can be diagnosed visually, so testing is not required.[5] To test for the high-risk kinds of HPV that can result in cervical cancer, there are a few common testing methods [5-6]:

  • Pap smear - Also called a Papanicolaou test, a Pap test examines the cells of the cervix to see if there are any abnormal changes prior to becoming cancerous. The cells are collected directly from the surface of the cervix with a swab or small brush.
  • Primary HPV test - An HPV test sample is collected in a similar manner to a Pap test, where cells from the cervix are collected with a small brush, swab, or spatula. The cells are then tested for the presence of HPV genetic material–this means that the strain of HPV can be identified. Most HPV tests specifically test for the high-risk strains HPV 16 and 18.

Sometimes, both types of tests are performed together. This is referred to as co-testing. HPV tests and Pap smears are often done during pelvic exams, but not always included. Be sure to ask your healthcare provider about which HPV testing method, if any, they are including as part of your pelvic exam.

How often do you need to get tested for HPV?

The American Cancer Society (ACS) has recently updated their guidelines for HPV testing. Currently, the guidelines include [7]:

  • Screening for cervical cancer should start at age 25 for people who have a cervix
  • Those aged 25-60 years should have a primary HPV test every 5 years. If a primary test is not available, then a co-test (with both an HPV and Pap test) every 5 years, or a Pap test every 3 years are acceptable.

The ACS advises that those who are vaccinated against HPV should still comply with the above screening guidelines.[7] Additionally, there are some groups who no longer need screening, such as some women over the age 65, as well as those who have had hysterectomies for certain medical reasons.

How can you reduce the risks of HPV?

The first step, and one of the most effective, to reducing the risks associated with HPV is to get vaccinated against the high-risk strains. The vaccines work best before you are exposed to HPV, so the CDC recommends vaccination in all people starting at the age of 11 or 12, and the vaccinations are FDA-approved.[5] For those who are sexually active, using barrier methods such as condoms during sexual intercourse can help prevent HPV transmission.

HPV infection is exceedingly common, and one of the most effective ways to handle any risks that may arise with infection is regular screening. Because it takes years for HPV to develop into cancer, pre-cancerous or abnormal cells can often be treated before they progress to cancer.[5]

What are the barriers to HPV screening?

There are many potential roadblocks and barriers to HPV testing, especially in the traditional setting. Studies have shown that many people find the traditional clinic setting to have a number of barriers to HPV screening. Some of the top reasons include:

  • Embarrassment - Due to the nature of the tests and sample collection, physical or emotional discomfort, or lack of social distance in a small town setting, many people report avoiding HPV screening from feeling embarrassed. [8,9]
  • Language or racial barriers - Patients report that clinics staffed largely or exclusively by those who speak only English, as well as clinics who do not display any racial diversity pose a social barrier for them to seek out HPV screening. [8-10]
  • Discomfort seeing male providers - The vast majority of people who receive HPV or Pap tests identify as women, and many report that seeing a male provider is a barrier to getting HPV screens, or pelvic exams in general. [8,10]
  • Lack of insurance or cost - The costs of healthcare are prohibitive to many people who are in need of HPV screenings, particularly those who are uninsured, or those who do not have in-network providers near them. [8-10].

There are numerous issues associated with following HPV screening guidelines. In many studies, HPV test self-collection has been shown to reduce or remove a number of barriers associated with traditional in-person care.[10, 11]. At-home self-sampling has been shown to be clinically effective, and has the added benefits of reducing or removing many of the top-reported reasons for avoiding screening. In the comfort and privacy of home, patients report feeling less embarrassed or uncomfortable, and more likely to comply with the ACS screening guidelines. [10,11]. For those who struggle with cost, self-collection methods can be lower cost than in-clinic visits. [10, 11].

HPV screening: what you need to know

Although most infections of HPV are harmless, there are still a number of cases that progress to serious conditions such as cancer. For this reason, taking measures to protect yourself against infection, like getting vaccinated and practicing safe sex, are important to consider. Regardless of whether you are vaccinated, or think you have contracted an infection, it’s important for people with cervixes to follow regular screening guidelines. Though there are a lot of people who report avoiding traditional in-person screening for a variety of reasons, at-home lab testing shows a promising option to help make HPV screening accessible to a larger number of people.

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References

  1. HPV Infection. Mayo Clinic. Accessed April 27, 2023. https://www.mayoclinic.org/diseases- conditions/hpv-infection/symptoms-causes/syc-20351596
  2. Braaten KP, Laufer MR. Human Papillomavirus (HPV), HPV-Related Disease, and the HPV Vaccine. Rev Obstet Gynecol. 2008;1(1):2-10.
  3. Incidence, Prevalence, and Cost of Sexually Transmitted Infections in the United States. Centers for Disease Control and Prevention. Published February 13, 2013. Accessed April 27, 2023. https://www.cdc.gov/nchhstp/newsroom/fact-sheets/std/STI-Incidence-Prevalence-Cost-Factsheet.html.
  4. Li K, Yin R, Wang D, Li Q. Human papillomavirus subtypes distribution among 2309 cervical cancer patients in West China. Oncotarget. 2017;8(17):28502-28509. doi:10.18632/oncotarget.16093
  5. Human Papillomavirus (HPV) Test. National Library of Medicine. Accessed April 27, 2023. https://medlineplus.gov/lab-tests/human-papillomavirus-hpv-test/
  6. Pap Smear. National Library of Medicine. Accessed April 27, 2023. https://medlineplus.gov/lab-tests/pap-smear/
  7. The American Cancer Society Guidelines for the Prevention and Early Detection of Cervical Cancer. American Cancer Society. Revised April 22, 2021. Accessed April 27, 2023. https://www.cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/cervical-cancer-screening-guidelines.html
  8. Parker SL, Deshmukh AA, Chen B, et al. Perceived barriers to cervical cancer screening and motivators for at-home human papillomavirus self-sampling during the COVID-19 pandemic: Results from a telephone survey. Preprint. medRxiv. 2022;2022.11.20.22282562. Published 2022 Nov 22. doi:10.1101/2022.11.20.22282562
  9. Racey CS, Gesink DC. Barriers and Facilitators to Cervical Cancer Screening Among Women in Rural Ontario, Canada: The Role of Self-Collected HPV Testing. J Rural Health. 2016;32(2):136-145. doi:10.1111/jrh.12136
  10. Zeno EE, Brewer NT, Spees LP, et al. Racial and ethnic differences in cervical cancer screening barriers and intentions: The My Body My Test-3 HPV self-collection trial among under-screened, low-income women. PLoS One. 2022;17(10):e0274974. Published 2022 Oct 13. doi:10.1371/journal.pone.0274974
  11. Nishimura H, Yeh PT, Oguntade H, Kennedy CE, Narasimhan M. HPV self-sampling for cervical cancer screening: a systematic review of values and preferences. BMJ Glob Health. 2021;6(5):e003743. doi:10.1136/bmjgh-2020-003743
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