HPV is diagnosed differently depending on where it shows up in the body and whether it’s causing symptoms. For cervical HPV, a molecular test can detect the virus directly from a sample of cervical cells. For genital warts, a visual exam is usually all that’s needed. And for men, there is currently no FDA-approved HPV test at all. Here’s how diagnosis works across each situation.
Cervical HPV Testing
The primary way HPV is detected in people with a cervix is through an HPV test, which looks for the genetic material of high-risk virus types in cervical cells. A clinician collects cells from the cervix using a small brush or spatula (similar to how a Pap smear is collected), and the sample is sent to a lab. There, the test identifies whether any of the HPV types most strongly linked to cervical cancer are present. One widely used method, called Hybrid Capture 2, screens for 13 high-risk HPV types in a single test. Newer mRNA-based tests take a slightly different approach, looking for active viral signals rather than just the presence of viral DNA, which can help distinguish infections that are actively progressing from those the body may clear on its own.
The HPV test is not the same thing as a Pap smear. The HPV test looks for the virus itself. The Pap test looks for abnormal cell changes on the cervix that could eventually become cancer. You can have HPV without any cell changes, and occasionally cell changes can appear without a detectable HPV infection. The two tests answer different questions, which is why they’re sometimes done together (called co-testing).
In 2024, the FDA approved two HPV tests, Onclarity and cobas, for self-collection in a health care setting. With these, you insert a vaginal swab yourself rather than having a clinician perform the collection. The sample is still processed in a lab. This option may make screening more comfortable and accessible for people who have avoided cervical screening in the past.
Current Screening Guidelines
The American Cancer Society recommends that people with a cervix at average risk start cervical cancer screening at age 25 and get a primary HPV test every five years through age 65. If a primary HPV test isn’t available, the alternative is co-testing (HPV test plus Pap smear) every five years, or a Pap test alone every three years. Before age 25, routine HPV testing isn’t recommended because HPV infections in younger people are extremely common and almost always resolve without treatment.
How Genital Warts Are Diagnosed
Genital warts, caused by low-risk HPV types (most often types 6 and 11), are diagnosed by visual inspection. A clinician examines the skin and identifies the characteristic raised or flat growths. No lab test is needed in most cases, and the CDC specifically notes that HPV testing is not recommended for genital wart diagnosis because the results wouldn’t change how warts are managed.
A biopsy is reserved for situations where the appearance is unusual. Lesions that are pigmented, hardened, bleeding, ulcerated, or fixed to deeper tissue warrant a biopsy to rule out something more serious. The same applies when warts don’t respond to treatment, get worse during treatment, or appear in someone with a weakened immune system. For warts that grow on the cervix, a biopsy is performed before treatment to make sure there aren’t high-grade precancerous changes underneath.
What Happens After an Abnormal Result
A positive HPV test or an abnormal Pap result doesn’t mean you have cancer. It means further evaluation is needed to determine whether the virus has caused cell changes worth monitoring or treating. The next step depends on several factors: your current test results, your previous screening history, any past treatments for cervical cell changes, and your age.
For many abnormal results, the recommended follow-up is a colposcopy. During this procedure, a clinician uses a magnifying instrument to closely examine the cervix. A mild vinegar solution is applied to the cervix, which causes abnormal cells to turn white and become visible. If a suspicious area is identified, a small tissue sample (biopsy) is taken and sent to a pathologist. The pathologist grades the abnormal cells on a scale of 1 to 3, called CIN (cervical intraepithelial neoplasia). CIN 1 represents mild changes that often resolve on their own. CIN 2 and CIN 3 indicate more significant changes that typically require treatment to prevent them from progressing toward cancer.
Specific Pap results that commonly lead to colposcopy include high-grade cell changes, atypical glandular cells, and certain ambiguous results that can’t rule out a high-grade abnormality.
HPV Diagnosis in Men
No HPV test has been approved by the FDA for use in men, and no test has been approved for detecting HPV in areas other than the cervix. This means there’s no routine screening test a man can request to find out if he carries the virus. In practice, HPV in men is typically diagnosed only when it causes a visible problem: genital warts identified by visual exam, or an HPV-related cancer detected through symptoms and biopsy.
Researchers have studied various detection methods in men, but none has gained regulatory approval. The lack of a standardized test means most HPV infections in men go undiagnosed, which is significant because many infections cause no symptoms and clear on their own.
Anal HPV Screening
For people at higher risk of anal cancer, including men who have sex with men and people living with HIV, anal HPV screening follows a process similar to cervical screening. It starts with an anal Pap test, where cells are collected from the anal canal and examined for abnormalities. If the results come back abnormal, the next step is high-resolution anoscopy.
During this procedure, a small tube called an anoscope is inserted to hold the anal canal open, and a colposcope (a high-powered magnifying device connected to a monitor) is used to examine the tissue in detail. Just as in cervical colposcopy, a vinegar-like solution is applied to highlight abnormal cells, which turn white in response. Iodine dye may also be used. If a suspicious area is found, a small biopsy is taken with forceps and sent to a lab for examination. The entire process is done in a clinic and helps catch precancerous changes before they develop further.
Oral HPV: No Standard Screening
There is currently no approved screening test for oral HPV. HPV-related cancers of the throat and base of the tongue (oropharyngeal cancers) are increasing in prevalence, but they are typically discovered through symptoms like a persistent sore throat, difficulty swallowing, or a lump in the neck, followed by biopsy. Saliva-based HPV tests exist in research settings but are not part of routine clinical practice, and a positive oral HPV result wouldn’t tell you whether cancer will develop. For now, oral HPV-related disease is diagnosed when it causes symptoms rather than through preventive screening.