HPV testing for women uses a sample of cervical or vaginal cells to detect high-risk strains of human papillomavirus, the virus responsible for nearly all cervical cancers. The preferred method is a primary HPV test every five years, starting at age 25. The test itself is quick, takes place during a routine office visit, and is covered at no cost under most insurance plans.
What the Test Actually Detects
An HPV test doesn’t look for cancer. It looks for the genetic material of high-risk HPV strains in your cervical cells. There are about a dozen high-risk types, including HPV 16, 18, 31, 33, 45, and 52. HPV 16 is the most common culprit: in studies of women with abnormal cervical findings, it shows up in roughly two-thirds of positive samples and is present in over 90% of invasive cervical cancer cases.
Two main laboratory approaches are used. DNA-based tests detect whether high-risk HPV is present in your cells. RNA-based tests (like the Aptima HPV Assay) go a step further by measuring the activity of two specific cancer-promoting genes within the virus. An active infection producing these proteins is more likely to cause cell changes than one that’s just sitting dormant. Both types of tests are clinically validated, and your provider chooses based on what’s available at their lab.
HPV testing is significantly more sensitive than a traditional Pap smear. It catches about 95% of high-risk infections, compared to roughly 55% for a Pap test alone. The tradeoff is a slightly lower specificity (94% versus 97% for Pap), meaning a small number of positive results won’t lead to actual cell changes. But the ability to catch nearly all dangerous infections is the reason HPV testing has become the preferred screening tool.
How the Sample Is Collected
During a standard pelvic exam, your provider inserts a speculum and uses a small brush or spatula to gently sweep cells from your cervix. The sample goes into a liquid vial and is sent to a lab. The whole collection takes under a minute. You may feel brief pressure or mild cramping, but it shouldn’t be painful.
If the idea of a pelvic exam is a barrier for you, there’s now another option. In 2024, the FDA expanded approval for two HPV tests (Onclarity by BD and cobas by Roche) to allow self-collection. You use a swab or brush to collect a vaginal sample yourself. The catch: it currently has to be done in a health care setting, such as a primary care office, pharmacy, or mobile clinic. It can’t yet be done at home, though the FDA is actively reviewing data that could make home-based self-collection available in the future.
Preparation Before the Test
No special preparation is required for an HPV test on its own. But since it’s often done alongside a Pap test, following a few guidelines helps ensure an accurate sample. Avoid intercourse for two days before the test. Don’t douche or use vaginal medicines, foams, creams, or spermicidal jellies. Try to schedule the appointment outside your menstrual period. The test can still be performed during your period, but your provider will get a cleaner cell sample at another point in your cycle.
When and How Often to Get Tested
The American Cancer Society recommends starting cervical cancer screening at age 25 and continuing until at least age 65. The preferred approach is a primary HPV test every five years. In some settings, your provider may instead offer co-testing, which combines an HPV test with a Pap smear, also done every five years.
After age 65, you can stop screening if you have a history of normal results. The exact criteria depend on how many negative tests you’ve had in the preceding years and whether you’ve ever had treatment for precancerous cervical changes. If you’ve had a hysterectomy that removed your cervix for reasons unrelated to cancer, screening is generally no longer needed.
HPV Testing During Pregnancy
Cervical cancer screening is safe during pregnancy. If you’re due for screening or have never been screened, your provider can perform the test at any point during pregnancy, though the early second trimester is considered ideal because the area of the cervix most relevant to screening is easier to access at that stage.
Many women skip screening during pregnancy out of fear of bleeding or harm to the pregnancy. Spotting after the sample collection can occur but is typically minor and not associated with any serious complications. The sampling tool matters: a cyto-broom is generally preferred over an endocervical brush because it causes less bleeding. During pregnancy, Pap smear results tend to be more reliable for guiding immediate decisions, since hormonal changes can make cervical cells look abnormal even when they’re not. A positive HPV result during pregnancy usually leads to closer follow-up rather than immediate intervention.
What a Positive Result Means
A positive HPV test does not mean you have cancer. Most HPV infections clear on their own within one to two years. What a positive result does is flag that your cervix is carrying a high-risk strain, and your provider needs to determine how closely to monitor you.
What happens next depends on your overall risk, which is calculated from your current test results, whether your Pap (if done) showed abnormal cells, and your screening history. The management guidelines from the American Society for Colposcopy and Cervical Pathology use risk thresholds to sort women into different follow-up tracks:
- Low risk: If your estimated five-year risk of developing serious precancerous changes is very low (below 0.15%), you return to routine screening every five years.
- Slightly elevated risk: If the risk is low but not negligible, you repeat HPV-based testing in three years.
- Moderate risk: If your risk falls between the thresholds for three-year follow-up and immediate colposcopy, you repeat testing in one year.
- Higher risk: If your estimated immediate risk of serious precancerous changes is 4% or greater, you’re referred for a colposcopy, a procedure where a provider examines your cervix under magnification and may take a small tissue biopsy.
In practical terms, many women who test positive for HPV with a normal Pap result will simply be asked to come back in one year for a repeat test. Testing positive for HPV 16 or 18 specifically often triggers a faster referral to colposcopy, since these types carry the highest cancer risk.
Cost and Insurance Coverage
Under the Affordable Care Act, HPV testing is classified as a preventive service. All Marketplace health plans and most other insurance plans cover it at no cost to you, with no copayment or coinsurance, as long as you use an in-network provider. This applies to both the HPV test and the Pap test when done as routine screening. If you’re uninsured, community health centers and programs like the CDC’s National Breast and Cervical Cancer Early Detection Program offer free or low-cost screening in many areas.