The makers of the test that can detect the human papillomavirus (HPV) are advertising it heavily these days, which is of course fine. But I notice that some of these ads seem to suggest that the HPV test is also a diagnostic test for cervical cancer. So, some of my patients who have tested positive for the virus are now coming in upset because they think that the positive test means they have cervical cancer. Wrong! Wrong! Wrong!

Yes, you should take a positive HPV test seriously because it indicates you've got a higher than average risk of eventually developing cervical cancer--but this is certainly not the same as a diagnosis of cancer.

Who gets HPV?

The human papillomavirus is a very common virus that infects humans. It rapidly infects the genital tract of almost everybody (80 percent of Americans over the lifespan) following the onset of sexual behavior in adolescence. Rates of HPV infection double from adolescence through college.

There are many versions of the virus, just as there are many strains of the flu virus. Some are very weak, in that they don't cause much trouble, while others will lead to genital warts, and still others to cancer of the cervix.

If the HPV has infected the genitalia, 1 of 3 things will happen: The infection will lead to changes that cause warts or cancer; the infection will be eradicated by the work of your immune system; or, the infection will linger indefinitely but will not cause any known disease.

What is the role in testing for this virus, then?

• Younger women. The role of the test in younger women will be quite limited because they will frequently test positive for an HPV infection but much less often will they go on to develop cancer or warts .
• Women still experimenting in their sexual relationships. The most important test for these women is the Pap smear and STD testing. For these women an HPV test is not routine but should be done.
• If a Pap smear is abnormal. An abnormal Pap-test result called ASCUS (atypical squamous cells of uncertain significance) means that the irregularity is only within the lowest degree of abnormal testing on the continuum to developing cancer. In this case, an HPV test willl determine the treatment:
  • ASCUS is found but HPV testing is negative. Routine annual screening can be safely continued.
  • ASCUS is found and HPV testing is positive. In this case, the woman is advised to seek the care of a gynecologist. (See my earlier blog "Abnormal Pap Smear: Now What?")
• Women in well established, monogamous relationships. HPV testing is done along with the Pap smear, if the she wishes to reduce the frequency of Pap smears.

If you have been monogomous for a good while and have had a series of adequate Pap smears that were negative, and the HPV test is now negative, then it is safe to reduce the frequency of Pap smear testing to every 2-3 years with a very limited  possibility that new cervical cancers will be missed. Some of my patients are thrilled at this prospect, while others are wary. If you like the idea of less frequent Paps, talk with your doctor to see if you qualify for this cervical cancer screening option and get the HPV test!

For those of you who have tested positive for HPV, it is okay!

Unless the Pap smear result also said you have cancer, your HPV infection can be managed and it should not cause you cancer. Simply maintain regular follow-up with your gynecologist to watch for any concerning changes on your cervix and get the treatments your doctor recommends.