Who Should Get The HPV Test - Under 30

Q

Who should get the HPV test?

A

If you have started getting regular Pap tests and are between 20 and 30, you should have an HPV test any time your Pap is inconclusive or borderline (also called an ASC-US Pap). The HPV test is used to determine whether or not you have an HPV infection and thus are in need of further examination.

The American College of Obstetricians and Gynecologists (ACOG) recommends you should get your first Pap test:

  • Within three years after you start having sex, OR 
  • When you are 21 years of age (whichever comes first).

After your first Pap, ACOG recommends that you repeat the test every year until you reach the age of 30. At that time, you should start getting the HPV test along with the Pap. However, because the HPV test is so sensitive, re-testing is needed just once every three years, as long as your results are normal.

Special note for women under 20: The consensus guidelines published in the October 2007 issue of the American Journal of Obstetrics & Gynecology do not recommend HPV testing for adolescents with inconclusive Paps (or in any other situation). This is because HPV infections are very common in sexually active girls, but are almost always short-lasting and harmless. Thus, the guidelines recommend that adolescents who have Pap smears that are inconclusive be re-tested with another Pap in 12 months. If the second Pap looks abnormal, a colposcopy exam is recommended. If the Pap is once again inconclusive, the guidelines say a third Pap should be done in another year (24 months after the first Pap). If the Pap does not appear clearly normal at that point, a colposcopy should be performed.



Q

Why shouldn't women younger than 30 get the HPV test routinely?

A

It's true that HPV infections are very common among young women. However, in the under-30 age group, HPV infections usually don't stay active for very long, since their immune systems are strong. As a result, cervical cancer is relatively rare in young women.



As women grow older, HPV infections become less common and those that exist are more likely to be the long-term, persistent type that can develop into cervical cancer. That's why it's recommended that women 30 and older be routinely tested for infection with high-risk types of HPV.

The rationale for recommending routine HPV testing only for older women is the same as that for mammography. Although some young women get breast cancer, it is not common enough to justify recommending regular mammograms for most women under the age of 40.



Q

Will women still need the HPV test if they get the HPV vaccine?

A

Yes. The HPV vaccine is only fully effective in women who are immunized before being exposed to the targeted types of HPV through sexual contact. In addition, the vaccine protects against only two of about 15 types of HPV that can cause cervical cancer, so the protection it offers is not complete. Thus, continued screening with both the Pap smear and (for women age 30+) the HPV test is critical.



Q

Do you still need an HPV test if your cervix has been removed?

A

If you had a total hysterectomy (including removal of the cervix) for reasons other than cervical cancer, then you no longer need a Pap or HPV test. However, if you had the hysterectomy due to a diagnosis of cervical cancer, most experts say it is important to continue to get the Pap and HPV tests. That is because HPV also can infect the vagina and vulva, causing cancer in those areas. (There is some evidence that women who have had cervical cancer are at higher risk of these types of cancer.) This is what physicians are looking for when they continue to do a "Pap" smear following a hysterectomy. (It's not really a Pap test in its traditional sense – in which a sample of cervical cells is examined – but rather a swab of the vaginal wall. Likewise, experts say the HPV test continues to be useful for the same reason, because it allows high-risk types of the virus to be detected in the "vaginal cuff" – the top of the vagina.)



Q

Do insurance companies pay for the HPV test?

A

Most insurance companies pay for HPV testing when healthcare professionals follow the guidelines developed by the American College of Obstetricians and Gynecologists (ACOG), American Cancer Society (ACS) and American Society for Colposcopy and Cervical Pathology (ASCCP). This means reimbursement almost always is available for HPV testing for women with inconclusive/borderline Pap results, as well as for routine HPV testing of women age 30 and older. For more information, visit our section on "Getting the HPV Test."



Q

Is the HPV test only for women? Why isn't there a test for men?

A

There is currently no FDA-approved HPV test for males. Men also get HPV, which can in turn cause genital warts or cancer of the anus and penis. However, serious HPV-related problems such as cancers are rare in men, especially those with healthy immune systems. In addition, it is hard to get a good cell sample from men to test for HPV, and thus the virus would frequently be missed.


Remember, It's personal!


This is general information about screening. Every woman is different. It's a good idea to discuss your screening schedule and the benefits and risks with your doctor.

In addition, even if you do not have to be screened every year for cervical cancer, it is recommended that you still visit your doctor or nurse regularly to have breast, pelvic or other important exams. Discuss with him or her how often you should be seen and for which tests.