HPV Test Results: Understanding Your Cervical Screening

What Is HPV and Why Is Testing Important?

Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide. HPV testing detects high-risk types that can cause cervical cancer. While most HPV infections clear naturally, persistent high-risk HPV can lead to cell changes that may develop into cancer over many years if untreated.

Human papillomavirus, commonly known as HPV, is a group of more than 200 related viruses. Of these, approximately 40 types can infect the genital area. HPV is so common that nearly all sexually active people will acquire at least one type of HPV at some point in their lives. The virus spreads through intimate skin-to-skin contact, which is why condoms provide only partial protection.

HPV types are categorized based on their potential to cause cancer. Low-risk HPV types (such as types 6 and 11) can cause genital warts but rarely cause cancer. High-risk HPV types (particularly types 16 and 18) can cause cell changes that may develop into cervical cancer and other cancers if the infection persists. HPV 16 and 18 alone are responsible for approximately 70% of all cervical cancers worldwide.

The good news is that cervical cancer is one of the most preventable cancers when detected early through screening. HPV testing has revolutionized cervical cancer prevention because it can identify women at risk years before cancer develops, allowing for monitoring and early treatment of precancerous changes.

How HPV Testing Differs from Pap Smears

Traditional Pap smears (cytology) examine cervical cells under a microscope to look for abnormalities. HPV testing, in contrast, looks for the genetic material (DNA) of high-risk HPV types in cervical cells. Many screening programs now use HPV testing as the primary screening method because it is more sensitive at detecting women at risk of cervical cancer.

Some screening programs use co-testing, which combines both the HPV test and Pap smear from the same sample. This approach provides comprehensive information about both the presence of high-risk HPV and any current cell abnormalities.

What Do Different HPV Test Results Mean?

HPV test results are reported as positive (high-risk HPV detected) or negative (no high-risk HPV detected). Some tests also identify specific high-risk types like HPV 16 and 18. Results may include cytology findings such as normal, ASCUS, LSIL, or HSIL, which indicate different levels of cell changes.

Understanding your HPV test results requires knowing what each component means and how they work together to guide your care. Modern cervical screening often provides several pieces of information that your healthcare provider uses to determine the best follow-up plan for you.

The primary HPV test result tells you whether high-risk HPV was detected in your cervical cells. This is a straightforward yes or no answer, but the implications depend on other factors including your age, previous screening history, and whether any cell changes were found. Some laboratories also perform genotyping, which identifies whether HPV 16 or 18 specifically is present, as these types carry higher risk.

Additional Cell Findings (Cytology Results)

If your test included cytology (Pap smear), you may see additional terms that describe your cervical cells. These findings help determine how urgently follow-up is needed and what type of follow-up is appropriate.

• Normal/NILM (Negative for Intraepithelial Lesion or Malignancy): Your cells appear healthy with no signs of abnormality
• ASCUS (Atypical Squamous Cells of Undetermined Significance): Minor cell changes that may or may not be significant
• LSIL (Low-grade Squamous Intraepithelial Lesion): Mild cell changes often caused by HPV, frequently resolve on their own
• HSIL (High-grade Squamous Intraepithelial Lesion): More significant cell changes that require further evaluation and usually treatment
• AGC (Atypical Glandular Cells): Abnormalities in glandular cells that require further investigation

What Does a Negative HPV Test Result Mean?

A negative HPV test result means no high-risk HPV was detected in your cervical cells. This is reassuring news indicating very low risk of cervical cancer in the coming years. Women with negative HPV results typically need screening only every 5 years, as the risk of developing cervical cancer is extremely low.

Receiving a negative HPV test result is excellent news. It means that at the time of testing, the laboratory did not detect any of the high-risk HPV types in your cervical cells. Because HPV is the necessary cause of nearly all cervical cancers, a negative test provides strong reassurance about your cervical health.

Research has shown that women who test negative for high-risk HPV have an extremely low risk of developing cervical cancer over the following years. This is why many screening guidelines now recommend longer intervals between tests for HPV-negative women. A negative result provides protection for approximately 5 years, which is longer than the protection provided by a normal Pap smear alone.

It's important to continue regular screening even after a negative result. While your current risk is very low, you could potentially acquire HPV in the future. Regular screening ensures that any new infections or changes are detected early. Your healthcare provider will advise you on the appropriate screening interval based on your age and medical history.

What Does a Positive HPV Test Result Mean?

A positive HPV test means high-risk HPV was detected, but this does not mean you have cancer or will develop cancer. About 90% of HPV infections clear naturally within 1-2 years. Your healthcare provider will recommend follow-up based on your specific results, which may include repeat testing in 1 year or colposcopy examination.

Learning you have a positive HPV test can understandably cause anxiety, but it's important to understand what this result actually means. A positive result indicates that high-risk HPV was found in your cervical cells at the time of testing. However, this is extremely common and in most cases does not lead to serious health problems.

The vast majority of HPV infections — approximately 90% — are cleared by the immune system within 1 to 2 years without any treatment. The virus simply goes away on its own, often without the person ever knowing they had it. Only a small percentage of persistent infections will lead to cell changes, and only a fraction of those will progress to cancer if left untreated over many years.

Think of a positive HPV test as an early warning system rather than a diagnosis of disease. It identifies women who need closer monitoring to catch any cell changes early, when they can be easily treated. The screening process is designed to identify and treat precancerous changes long before cancer develops.

Understanding HPV 16 and HPV 18 Results

Some HPV tests provide specific information about whether HPV 16 or HPV 18 is present. These two types are considered the highest risk because they are responsible for about 70% of cervical cancers. If your test shows HPV 16 or 18, your healthcare provider will typically recommend colposcopy even if your cells appear normal, because the risk of significant cell changes is higher with these specific types.

However, even with HPV 16 or 18, the majority of women will not develop cancer. The increased surveillance ensures that any changes are caught early. Many women with these high-risk types will clear the infection naturally, just like other HPV types, though it may take longer.

What If My Test Shows Abnormal Cells?

Abnormal cells (ASCUS, LSIL, or HSIL) indicate changes in cervical cells that may be caused by HPV. LSIL often resolves on its own, while HSIL requires treatment. Your healthcare provider will recommend colposcopy to examine the cervix more closely and may take biopsies to determine the extent of changes.

If your screening results include cytology findings showing abnormal cells, it means the laboratory observed changes in how your cervical cells appear under the microscope. These changes exist on a spectrum from minor to more significant, and the terminology used describes where your cells fall on this spectrum.

ASCUS (Atypical Squamous Cells of Undetermined Significance) is the mildest abnormality and simply means cells look slightly different from normal. These minor changes may be caused by HPV infection, inflammation, or other factors. If you have ASCUS but are HPV negative, you typically just need routine follow-up. If you have ASCUS and are HPV positive, further evaluation is usually recommended.

LSIL (Low-grade Squamous Intraepithelial Lesion) indicates mild cell changes commonly caused by HPV infection. The term "low-grade" means the changes are mild and superficial. Many LSIL findings, especially in younger women, resolve on their own as the immune system clears the HPV infection. Management may involve watchful waiting with repeat testing or colposcopy depending on your age and previous history.

HSIL (High-grade Squamous Intraepithelial Lesion) indicates more significant cell changes that are considered precancerous. HSIL requires colposcopy and usually treatment to remove the abnormal cells before they can progress. Treatment for HSIL is highly effective, and the vast majority of women treated for HSIL never develop cervical cancer.

Understanding CIN Grades

If you have a colposcopy with biopsy, the pathology results will be reported using the CIN (Cervical Intraepithelial Neoplasia) grading system. This system describes how much of the cervical tissue thickness shows abnormal cells:

• CIN 1: Mild dysplasia affecting only the lower third of the epithelium. Often resolves without treatment.
• CIN 2: Moderate dysplasia affecting up to two-thirds of the epithelium. May be monitored or treated.
• CIN 3: Severe dysplasia or carcinoma in situ affecting more than two-thirds of the epithelium. Treatment is typically recommended.

What Happens After Receiving HPV Test Results?

Next steps after HPV testing depend on your specific results. Negative results mean routine screening in 5 years. Positive HPV results may require repeat testing in 1 year or colposcopy. If cell abnormalities are found, colposcopy with possible biopsy is typically recommended to determine appropriate management.

Your healthcare provider uses evidence-based guidelines to determine the most appropriate follow-up for your specific situation. These guidelines consider multiple factors including your HPV status, any cell abnormalities found, your age, and your previous screening history. The goal is to provide adequate surveillance without unnecessary procedures.

Repeat Testing (Surveillance)

For some results, the recommended follow-up is simply to repeat the test in 6 to 12 months. This approach is often used when the risk is elevated but not high enough to warrant immediate colposcopy. For example, a woman with HPV positive but normal cytology might be asked to return in one year. If the HPV clears (which happens in most cases), she can return to routine screening. If it persists, colposcopy may then be recommended.

Colposcopy Examination

Colposcopy is a closer examination of the cervix using a special microscope called a colposcope. During the procedure, a healthcare provider applies a dilute vinegar solution to the cervix, which causes abnormal areas to turn white and become visible. The colposcope magnifies the cervix so the provider can identify any abnormal areas.

If abnormal areas are seen during colposcopy, small tissue samples (biopsies) may be taken for examination under a microscope. Biopsies provide definitive information about whether precancerous changes are present and their severity. Most women describe biopsies as causing brief cramping similar to menstrual cramps.

Treatment Options for Cell Abnormalities

If significant precancerous changes (CIN 2 or CIN 3) are confirmed by biopsy, treatment is typically recommended. The most common treatment is LEEP (Loop Electrosurgical Excision Procedure), which uses a thin wire loop with electrical current to remove the abnormal tissue. Other treatment options include:

• LEEP: Removes abnormal tissue using an electrically charged wire loop
• Cryotherapy: Freezes and destroys abnormal cells
• Laser therapy: Uses laser to remove abnormal tissue
• Cold knife conization: Surgical removal of a cone-shaped piece of tissue

These treatments are highly effective at preventing cervical cancer. After treatment, you will need follow-up testing to ensure the abnormal cells have been completely removed and to monitor for any recurrence.

When Should You Contact Your Healthcare Provider?

Contact your healthcare provider if you have questions about your results, haven't received results within 3 weeks, experience unusual symptoms like bleeding between periods or after intercourse, or need clarification about recommended follow-up. Always attend scheduled follow-up appointments to protect your cervical health.

While HPV test results rarely indicate an emergency, there are situations when you should reach out to your healthcare provider for guidance or further evaluation.

It's important to attend all recommended follow-up appointments. The screening and follow-up process is designed to catch any problems early when they are most treatable. Missing appointments or delaying follow-up can allow cell changes to progress that could have been easily treated.

How Can You Reduce Your Risk of HPV-Related Problems?

You can reduce HPV-related health risks through HPV vaccination (most effective before sexual activity begins), regular cervical screening, not smoking (smoking weakens the immune response to HPV), and maintaining a healthy immune system. While condoms provide partial protection, HPV can spread through any intimate skin-to-skin contact.

Prevention strategies for HPV-related disease work at multiple levels, from preventing infection in the first place to ensuring early detection and treatment of any problems that do arise.

HPV Vaccination

HPV vaccines are highly effective at preventing infection with the HPV types that cause most cervical cancers and genital warts. The vaccines work best when given before exposure to HPV, which is why vaccination is recommended for adolescents. However, vaccination can still provide benefit for adults who haven't been previously vaccinated, up to age 45 in many countries.

It's important to note that even vaccinated women should continue cervical screening, as the vaccines don't protect against all cancer-causing HPV types. However, vaccinated women have significantly lower rates of HPV infection and cervical abnormalities.

Lifestyle Factors

Certain lifestyle factors can affect how your body responds to HPV infection:

• Don't smoke: Smoking weakens the cervical immune response and makes it harder for your body to clear HPV infections. Smokers are more likely to have persistent HPV and develop cervical abnormalities.
• Support your immune system: A healthy immune system is better able to clear HPV infections. This includes getting adequate sleep, managing stress, eating a balanced diet, and exercising regularly.
• Attend regular screening: Perhaps the most important thing you can do is attend cervical screening appointments as recommended. Screening catches changes early when they are easily treatable.

Coping with HPV Test Results

It's normal to feel anxious or worried after receiving HPV-related test results. Remember that HPV is extremely common, most infections clear naturally, and regular screening catches problems early. Talk to your healthcare provider about any concerns, and seek support from trusted friends, family, or counselors if needed.

Learning that you have HPV or abnormal cervical cells can trigger a range of emotions including anxiety, fear, confusion, or even shame. These feelings are completely normal, but it's important to keep the results in perspective.

HPV is so common that it's considered a normal part of being sexually active. Having HPV does not reflect on your character or behavior — most people acquire HPV at some point regardless of their number of partners. The infection is not a result of being "dirty" or "promiscuous," and there is no reason to feel ashamed.

If you're feeling anxious about your results, it may help to:

• Talk to your healthcare provider about your specific results and what they mean for your health
• Learn about HPV and cervical screening so you understand the process
• Share your concerns with a trusted friend or family member
• Remember that the screening process is designed to keep you healthy
• Focus on what you can control, like attending follow-up appointments