HPV & testing FAQs
What is HPV?
It stands for Human Papillomavirus, a sexually transmitted infection (STI). It is the most common STI in the world and is transmitted by skin to skin contact. Anyone who is sexually active is at risk for HPV and about 80% of people who have had any sexual contact will have an HPV infection at some point in their lives, but it often has no signs or symptoms. HPV can cause genital warts, cervical cancer, or its precursors, and has also been associated with anal, vaginal and head and neck cancers. It is estimated HPV is the cause of approximately 5% of all cancers worldwide; however, not all HPV causes cancer, and having HPV doesn't mean a person will develop cancer. Most times, HPV clears on its own, within about two years, without a person ever knowing they had it. It is only long-term persistent infection with a cancer causing type of HPV that may lead to cervical cancer if left undetected and untreated.
There are about 100 types of HPV, and about 40 of them can infect the genital region. There are "low-risk" and "high-risk" types of HPV. Low-risk types are commonly associated with genital warts and do not cause cervical cancer. The two most common low-risk types are HPV 6 and 11. There are 13-15 high-risk types that are associated with cervical cancer. HPV 16 and 18 are the most common types and cause about 70% of cervical cancer cases around the world.
How do you catch HPV?
HPV is transmitted through sexual contact and not just sexual intercourse or penetration. It can be transmitted through skin to skin contact, touching, oral, vaginal or anal sex and through contaminated sex toys. Condoms may provide some protection against HPV but condoms don't cover all skin areas and cannot offer complete protection.
There are three vaccines available that protect against the most common high-risk HPV types that are attributable to cervical cancer in women. Two of these vaccines also protect against two of the most common low-risk types that cause genital warts. Refer to: "What is the HPV Vaccine and who can get it" question for more information.
Is HPV the only cause of cervical cancer?
HPV is the cause of cervical cancer. HPV types 16 and 18 are responsible for about 70% of cervical cancer cases alone. Most of the time HPV goes away on its own about two years after the infection when the body's immune system fights it off. It's only when high-risk (cancer causing) types of HPV persist for many years (usually 10 or more) that cancer may develop. However, presence of HPV alone is not sufficient to cause cancer. Some factors that may put people at risk for developing cancer after long term HPV infection are: smoking, having multiple sex partners, or having a weak immune system. It is not possible to predict who will develop cancer as a result of an HPV infection.
Why do I need HPV testing? Or, why change from the Pap test?
The Pap test has been very successful in decreasing cervical cancer rates in areas where Pap testing is widely available. However, now that it is known that the cause of cervical cancer is HPV, tests have been developed to detect the presence of HPV. Pap testing detects changes to the cells on the cervix once they have
already occurred. Whereas, HPV testing detects for the presence of HPV, which is the virus that causes cell changes to the cervix, giving us the ability to identify women at risk for having changes to the cells of the cervix, often before they develop.
HPV has
always caused cervical cancer, but when screening first started this wasn't known and previously the ability to test women for HPV wasn't available. Since we now know what causes cervical cancer, technology has advanced so that HPV testing is available to detect this virus that is the cause of cervical cancer.
Screening programs are planning to eventually move away from the Pap test as the first method of screening for cervical cancer for women of certain ages, and will start to use HPV testing which is very good at identifying women at risk for having cell changes that may lead to cervical cancer. If you have ever had any sexual contact you should receive cervical cancer screening.
What's the difference between Pap and HPV testing?
The Pap test identifies changes to the cells of the cervix that can lead to cervical cancer. The Pap test may sometimes miss detecting abnormal cells, as it is not always 100% accurate. To enhance the performance of the Pap, women are recommended to have a Pap every two or three years, not because cervical cancer grows quickly.
HPV testing identifies the presence of the virus that causes abnormal cells that lead to cervical cancer. It's very good at detecting HPV if it is present. If a woman tests negative for HPV, the chances she has HPV or changes to cells on her cervix are very low. As a result, women can go longer between negative HPV tests, than they can between negative Pap tests. This means that cervical cancer screening with HPV will happen less frequently than cervical cancer screening with Pap smears, but it is safe and at least as accurate. If a woman tests positive for HPV, then additional testing can be done to determine next steps.
Is it safe to go for 4 or 5 years without another screen?
Due to the differences between Pap and HPV testing, and the accuracy of HPV testing, it is safe to go longer between screens than you are used to with Pap testing. If you test negative for HPV, the chances of having or being at risk for cell changes that cause cervical cancer are very low. Some studies have shown that one negative HPV test every 5 years is at least as safe as having a Pap smear every 3 years. Also, it's important to remember that HPV is very common in the population and most times, when people get an HPV infection, it goes away on its own, without a person even knowing they have it. If you test for HPV too often, or in women too young, it is possible HPV infections will be detected that would otherwise go away on their own, and this could lead to anxiety and or treatment that is unnecessary.
Why shouldn't younger women (under 30 yrs) get HPV testing?
HPV is very common in people under the age of 30 but it usually goes away on its own without causing any health problems. If HPV testing is done in younger women, it will detect infections that the body will fight off on its own, leading to follow-up and management that may not be necessary. It's also important to recognize that cervical cancer is very rare in women under the age of 30. As women get older, new HPV infections are less common, and it's more likely that HPV found may be an infection caught years ago that the body did not clear on its own. Therefore, only doing HPV testing in women over 30 allows us to identify those at higher risk for having cell changes on the cervix that need to be followed more closely.
This does not mean younger women should NOT be screened for cervical cancer. Cervical cancer screening with the Pap test is recommended for women of screening age, not yet eligible to receive HPV testing. Ask your care provider what the cervical cancer screening guidelines are in your region.
If the test shows I'm HPV negative, but then I'm exposed to HPV shortly after that, shouldn't I have another test sooner than later?
It is not necessary to have HPV testing more frequently than is recommended. It's important to remember that HPV is very common in the population and most times, when people get an HPV infection, it goes away on its own, without a person even knowing they have it. If you test for HPV too often, it is possible HPV infections will be detected that would otherwise go away on their own and this could lead to anxiety and or unnecessary treatment. It's only persistent HPV infections that last many years (usually more than 10) that may cause cell changes on the cervix that could lead to cervical cancer. HPV testing has been shown to be very safe (one HPV test every 5 years is at least as safe as a Pap smear every 3 years) and is not necessary to have HPV testing more often than recommended by the screening program, regardless of if you are exposed to HPV shortly after a negative test.
I have been with the same partner for many years, why do I need HPV testing?
Cervical cancer screening is recommended for
all women of screening age, who have had any sexual contact, regardless of how many people you have had sexual contact with, or how long in the past or how recent sexual activity has been.
Should I get HPV testing every time I have a new partner?
It is not necessary to have HPV testing more often than recommended, even if you have new sexual partners. It's important to remember that HPV is very common in the population and most times, when people get an HPV infection, it goes away on its own, without a person even knowing they have it. If you test for HPV too often, it is possible HPV infections will be detected that would otherwise go away on their own and this could lead to anxiety or unnecessary treatment. It's only persistent HPV infections that last many years (usually more than 10) that may cause cell changes on the cervix that could lead to cervical cancer.
It's important to know that HPV testing does
NOT check for other sexually transmitted infections. If you have concerns about other STIs or have questions, please discuss with your health care provider or refer to the following website:
Health Link BC:
https://www.healthlinkbc.ca/illnesses-conditions/sexual-reproductive-health
I haven't been sexually active for many years, why do I need HPV testing?
If you are a woman of screening age, and have ever had any sexual contact, regardless of how far in the past that contact was, it's important to receive cervical cancer screening as recommended by the screening program.
I have had genital warts, so I know I'm HPV positive, why do I need HPV testing?
There are two types of HPV: "low" and "high" risk types. The types of HPV that cause genital warts are called "low-risk" types and are not associated with cervical cancer. HPV testing does not detect these "low-risk" types. HPV testing detects the high-risk strains that are associated with cervical cancer. Therefore, all women should have cervical cancer screening, even if you have had, or been exposed to genital warts.
I suspect I have been exposed to genital warts. Can I get HPV testing to see if I will get them?
There are two types of HPV: "low" and "high" risk types. The types of HPV that cause genital warts are called "low-risk" types and are not associated with cervical cancer. HPV testing does not detect these "low-risk" types. HPV testing detects the high-risk strains that are associated with cervical cancer. Being screened with HPV testing will not show if you have or will develop genital warts.
What's the cure for HPV (or) How is HPV treated?
There is no cure or treatment for HPV itself. HPV is very common, and most times a person can clear an HPV infection with their own immune system; however, this does not mean you are then immune to HPV. It is possible to catch HPV again if you are exposed in the future.
Although there is no treatment specifically for HPV, treatment can be aimed at problems associated with HPV infection. If there are abnormal cells on the cervix you may require a colposcopy, which is a procedure that allows the doctor to have a closer examination of your cervix than can occur during routine screening. Depending on the findings at colposcopy, treatment may be required to remove the abnormal cells from your cervix.
What is the HPV vaccine, and who can get it?
HPV vaccines are highly effective at protecting against genital warts and several of the HPV types that are responsible for cervical and other cancers. There are now vaccines available that protect against 2, 4, or 9 HPV types. In Canada, HPV vaccination is approved for females (9-45yrs) and males (9-26yrs). HPV vaccines have been researched and used for many years and are safe. Across Canada, HPV vaccination is offered to girls through school based immunization programs. In some provinces, boys may also receive the vaccine in school. Outside of these school based programs, individuals must pay for the HPV vaccine themselves. The best time to receive the HPV vaccine is before any sexual activity has occurred. However, even if you have been exposed to one or more types of HPV, the vaccine may still be of benefit to you.
If you would like to know if you are a candidate for HPV vaccination, speak to your health care provider who can answer any of the questions you have and discuss your options.
Comprehensive information available on HPV vaccination in Canada can be found on the following websites:
Please speak to your health care provider for HPV vaccination guidelines and information specific to your province.
How can HPV be prevented?
Total abstinence, with no sexual contact of any kind is the only way to completely prevent HPV infection. However, there are steps that can lower your risk of getting HPV.
- Vaccines: Other than abstinence, HPV vaccination is the best protection against HPV infections.
- Reduce the number of sexual partners you have: The less sexual partners you have the less chance you will be exposed to HPV. If you have sexual contact with a partner who has had many sexual partners, you increase your chances of catching HPV.
- Wear condoms: Although condoms won't completely eliminate the risk of HPV transmission they can reduce the risk and are effective protection against other sexually transmitted infections.
- Do not smoke: Smoking may impair the body's own ability to fight off HPV and other infections.
- Go for cervical cancer screening as recommended.
Should my boyfriend/husband get HPV testing?
At this time, there is no approved test for HPV in men. Serious health complications related to HPV in men are rare; therefore, there are no general HPV screening recommendations for men. In the absence of such screening, it is important men see their health care providers for regular check-ups or to have any specific signs and symptoms investigated.
How can I tell if a partner has HPV?
It is not possible to tell when someone has HPV unless you can visibly see genital warts. HPV usually has no signs or symptoms. It's important to remember the HPV is very common and over 75-80% of sexually active people will have an HPV infection at some point in their lives.
I've had the HPV vaccine, why do I still need cervical cancer screening?
HPV vaccination is highly effective at protecting against several types of HPV but not every type; therefore, it is still important to be screened for cervical cancer as recommended by the screening program.
If I have an HPV test, can I still get a Pap test every year?
It is not necessary to have Pap tests in addition to HPV testing for cervical cancer screening. HPV testing screens for the presence of the virus that causes cervical cancer. Pap testing identifies changes on the cells of the cervix caused by HPV, once these changes have already occurred. If you are HPV negative, it is unlikely the cells of your cervix have any abnormalities, and you can safely wait until you are due for another HPV test as recommended by the screening program.
Useful resources for women:
