How is Human Papillomavirus (HPV) Tested & Diagnosed?
The issue of sexual health has constantly draped the community, and most often than not, the topic itself is met with hushed tones due to the several stereotypes and the stigma that has long been attached to this conversation.
Over the years, there have been some advances in the promotion of a more acceptable approach toward sexuality, and this has successfully been able to provide individuals who need some help when it comes to their sexual needs with an avenue wherein they can voice out their demands and concerns.
However, despite this pseudo-acceptance that people seemed to have just accepted as is – thinking that the issue is already resolved and there is no longer a need to fight for a more open discussion of the entire field – the sentiment of many towards actually discussing the things that matter in this issue has been lukewarm. Sure, there have been more conversations regarding sexuality, but the discussions have mainly revolved around pleasure and performance, and it somehow missed the core aspect of the movement and pushed for a more participative exchange.
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The conversations about sexuality seem to have been trivialized. Many freely discuss it to either compare their performance or ask for help regarding what can help them with their performance and how they can make the entire experience more effective and pleasurable. Sure, we do sympathize with these concerns as they are likewise considered under the push for a more open discussion, but completely missing the topic of sexual health problems such as infections, disease, infertility, erectile dysfunction, and many other issues seems incongruent with the original purpose of this call.
The primary thing that has long needed some attention is the community’s knowledge about the several conditions that may plague the genitalia and arguably, may also result in more severe infections that can sometimes be life-threatening if not managed correctly. As such, it is much more crucial that, apart from pushing for an extensively open discussion, we would also try to shift the focus into understanding sexual health issues and the things that one needs to take note of to take care of their sexual capabilities – preventing subsequent complications that might cause even more problems in the long run.
The public needs consistent education about what we need to look out for, where and when to seek help, what we should do initially to avoid the condition's progression, and many other things relevant to taking care of your reproductive system.
Considering that it is also hard to identify what condition you might have from a simple examination of your presentations, this entire movement is even more critical, primarily since it provides the necessary knowledge of how certain conditions can be diagnosed and managed correctly.
In the case of human papillomavirus infections or HPV, its importance becomes even more emphasized due to its widely asymptomatic prevalence and the overlap of its symptoms with the manifestations of other conditions. As such, if you have observed something unusual within your genitalia and have the relevant risk factors associated with such infections, perhaps ruling out each possible condition one by one will go a long way in narrowing down the appropriate management strategies that you can use do for your condition.
With that in mind, you may start with determining how HPV infections are recognized in the first place and what you can do, as a patient, to have your condition diagnosed and appropriately managed.
Without further ado, let us flesh out what you might need to do to get the care you need if you potentially have this condition.
To begin with, perhaps the most essential thing that you can do is understand what HPV infections are, what HPV is initially, and how the entire disease comes into play when attempting to recognize a particular manifestation and presentation that you might.
However, note that while this entire outline promotes the examination of these conditions and what is usually prescribed and recommended to treat these conditions, a proper test and consultation from your doctor is still necessary to have a conclusive diagnosis. In addition to that, the treatment strategies available for many conditions are usually restricted by prescriptions, and you will only be able to avail of these if you can consult your physician regarding your concerns.
Again, although we want to promote a more knowledgeable community regarding these concerns, we still need you to be responsible enough to seek help from the professionals who are more informed about the steps that you can take following this.
HPV infections are caused by the microorganism known as the human papillomavirus. This pathogen is primarily transmitted through direct contact with an infected surface or, in most cases, infected genitalia. The transmission may occur even when the patient is not showing any symptoms, causing the condition's high prevalence even though its preventive and management strategies are relatively straightforward to understand.
As mentioned, HPV infections are widely asymptomatic, and in most cases, it is hard to determine what exactly you will experience when your partner infects you. However, in cases where the condition becomes symptomatic, it is primarily caused by genital warts within the genitalia if the transmission has been sexual – except, perhaps, when you participated in anal and oral sex as well, which may cause the presentations to appear in the throat or the lining around the anus.
Genital warts can primarily be described as bumps or a small group of bumps that may appear within the penile region, in the vagina, around the anus, or in the cervix and vulva. They are either large or small depending on how extensive the condition is, and they can either be pinkish flat or cauliflower-shaped bumps that form within the genitalia’s premises.
The prevention strategy for HPV infections is almost similar to the preventive approach for another sexually transmitted disease as the primary transmission mechanism of the condition is sexual in nature. This may include abstinence to ensure that the point of contact is entirely removed from the equation – resulting in a 100% guaranteed safety from such infections, monogamy to ensure that you can keep track of your partner’s health status to ensure that you will not be unknowingly exposed to someone who might have an active infection, and using a condom to minimize the point of contact between your genitalia during intercourse. These can significantly reduce the risk for a disease as this eliminates some components of the virus’ mechanism, but do note that it still cannot guarantee complete protection unless you opt for total abstinence.
Oh, and vaccination may work too, but take note of the age range where it will be most effective to ensure that you will get the full effects of this intervention.
Several treatment approaches can be made for symptomatic HPV cases, but there has been no determined solution to eradicate the viral infection itself. In cases where the patient develops genital warts, the bumps are often removed using liquid nitrogen or electrocution to ensure that the bumps are safely removed without harming the underlying skin surface. On the one hand, in cases where the patient developed cancer due to a high-risk strain of HPV, then perhaps their treatment would be tailored to their condition depending on several factors that an oncologist would have to consider before anything else.
The most common complication of HPV infections is the development of several types of cancers, primarily due to being infected by a high-risk HPV strain. In women, the most common complication is cervical cancer, especially if the infection is left untreated or undiagnosed for quite some time, while in men they may experience penile, anal, or throat cancer, albeit rarely and more unlikely than the case among women.
If you have doubts or are struggling to see the importance of having to be tested for HPV, then perhaps answering the several questions you might have regarding the test, and its significance will provide you with the information you need moving forward.
HPV infections are generally harmless, and this is the common thing that encourages people to underestimate the untoward health effects of such a condition when left alone for so long. HPV infections resolve independently after around 2 years, even without intervention, but that is not always the case for affected patients.
The pathogen HPV has several strains that could affect humans and cause the same manifestations, but certain ones are considered high risks, such as HPV-16 and HPV-18. Both HPV strains may cause the development of several cancer types when the condition is not treated immediately, and this may be due to the consistent and more severe damage that it causes to the structure and genetic print of the cells within the genitalia.
As such, when we consider that HPV infections, while harmless at first, could cause a full-blown condition that may cause further expenses and a more miserable quality of life, later on, it becomes more apparent that the condition should be identified as soon as possible, and that the infection is resolved immediately.
If you are sexually active or at risk for developing an HPV infection, you might consider routine screening for the condition to ensure that you do not have the disease, even when you do not have any significant symptoms. Again, HPV infections are widely asymptomatic, and looking for them is the best way to recognize them in the first place.
In the case of women, it is best to be tested every 3 to 5 years using both a pap smear and HPV DNA testing, as these are the two primary procedures done for the diagnosis of the condition.
The procedures employed to diagnose a potential HPV infection are relatively invasive as it involves using a speculum that will then collect a scraped cell sample from the genitalia itself. The cells are mainly collected within the cervical area, and you may expect some discomfort while the doctor is using a metal spoon-like tool to scrape off the necessary samples from this region.
Before doing the test itself, it is recommended that you avoid douching, having intercourse, taking a bath, or using tampons, as these procedures may compromise the area and produce either false positive or negative results during analysis.
The rule of thumb when recommending routine screening for HPV is that all sexually active individuals should be routinely screened for STDs, including a potential HPV infection.
Please do note, however, that the screening programs for HPV infections are not as inclusive as one might expect from a widely prevalent condition, but it does cover the population who are at most risk for developing the disease.
According to the Centers for Disease Control and Prevention, anyone who is sexually active, except for men, adolescents, and women under the age of 30, is recommended to undergo routine screening every 3 to 5 years to rule out any potential infection that may cause severe complications later on.
Overall, only two tests are highly recommended for the diagnosis of HPV [WT4] infections, albeit these are still relatively non-inclusive as it is not indicated for use in men. However, we still highlighted the tests in the tables below, along with the necessary parameters that are often relevant in understanding these procedures, to still provide the information that might be essential for you at some point:
Pap Smear or Pap Test | HPV DNA Test or HPV Typing | |
Sample Required | Cervical scrape | Cervical scrape |
Waiting Time | 1 to 3 weeks | 1 to 3 weeks |
Tool Used | Speculum and Microscopic Analysis | Speculum and Microscopic Analysis |
Indication | Determine the presence of any cellular abnormalities | Determine the presence of high-risk HPV strains |
If you perfectly fit the criteria that have been previously mentioned or if you are considering having yourself tested due to a suspicious manifestation, the following tests are typically performed in practice by licensed professionals during a consultation:
A Pap Smear or a Pap Test is a procedure routinely done among women who are of child-bearing age and those who are sexually active. Typically, this is performed after the age of 21, but the recommendation of the CDC for routine pap testing should start at around the age of 30 for women. Meanwhile, the procedure itself is not recommended for men unless they are at high risk for developing anal cancer, as the side effects and limitations of the test outweigh the benefits that it has for being performed routinely in this population.
The primary purpose of pap testing in women is to determine the presence of any abnormal cells such as those that are already precancerous – making it essential in screening for potential cervical cancer cases, or in this case, for likely precursor conditions such as an HPV infection.
The test itself is routinely done along with HPV typing if the indication is for the diagnosis of an HPV infection as a pap test alone cannot accurately determine the presence of the virus, albeit it is relatively reliable in the determination of any problems within the cervix.
Before the test, there are some things that you might want to take note of to ensure that your results are accurate:
The Procedure
The procedure is pretty simple for licensed professionals such as gynecologists.
First, you will be asked to lie down on the bed in a supine position, and then you will have to place your legs on the stirrups that serve as support for your legs while it is raised.
Following that, your doctor will then insert a metal apparatus known as a speculum into your vagina, continuing towards the cervical area. This will essentially keep your vagina open as the doctor collects a sample.
The doctor will then collect cellular samples from the cervical walls, which can be done through a spatula, a brush, or a cytobrush.
The sample will then be sent to the laboratory, and the interpretation of the results will be as follows:
The Timeline
Pap smear results are typically released in around 1 to 3 weeks, depending on the facility, as the sample needs to be manually analyzed through microscopy.
The Sample Required
A pap smear, similar to what was previously discussed, will only require a cell sample scraped from the cervical walls of the vagina.
The Expenses
When paying out of pocket for a pap smear, you may find its prices within the range of around $24 to $150, depending on the facility of your choice.
The Insurance Coverage
Fortunately, pap smears are covered by most insurance packages because the procedure is highly recommended for women.
The Accuracy of the Test
The accuracy and sensitivity of the test for HPV-induced cervical cancer are hard to deduce due to the uncertainty of several factors involved. However, according to recent studies, the test has been shown to reduce cancer rates and mortality by up to 80%.
HPV DNA Testing or HPV typing is considered a supplementary test to pap smears. It determines the specific strain of HPV that might be causing your presentations – subsequently providing you with the information as to whether the strain is a high-risk type that may cause cancers when left untreated.
To prepare for this procedure, you would have to take note of some things that you might have to avoid or do at home:
The test will generally feel uncomfortable, and you may feel some pain as the sample is being collected, but rest assured that the pain is manageable nonetheless.
The Procedure
Performing an HPV DNA test is almost similar to how a pap smear is performed, albeit its final procedures are somewhat different since the analysis would depend on biochemical analysis of the cellular sample and the present virus.
Essentially, HPV typing is performed simultaneously with a pap smear. You would first have to lie on the examination bed and place your legs on the stirrup to raise your legs. Then, a speculum will be inserted in your vagina to open up the area and expose the cervix for sample collection.
A sample will then be collected by scraping the walls of the cervix using a spatula, and then the cells will be sent to a laboratory for examination. The genetic material will be examined, and the following HPV types or strains would usually mean that the result is normal:
HPV-16 and HPV-18 are considered high-risk types and are therefore flagged for further examination, while other HPV types other than the ones included in this outline are rarely found during analysis.
The Timeline
Like pap smears, HPV typing results could take up to 1 to 3 weeks for results to be released.
The Sample Required
The sample required for HPV typing is a cervical scraping containing cell samples.
The Expenses
The prices for the test may vary, but the average price for an out-of-pocket purchase of an HPV typing test may be around $30.
The Insurance Coverage
Considering that the HPV typing test is supplementary to a pap smear procedure, the same test is covered by most insurance policies. However, do review your premium coverage to ensure that you are covered for the test.
The Accuracy of the Test
HPV typing has a sensitivity rate of 77.8% and a specificity rate for HPV of 80.8%.
A very prominent complication of HPV infections among women is cervical cancer, and perhaps it might be efficient likewise to have a rough idea of what diagnostic tests can be performed in case you have this particular condition:
To have a better understanding of what is in store for you if in case you choose to get tested for the condition due to some concerning presentations, the following are the expenses that you might incur when taking the tests:
Pap Smear or Pap Test | HPV Typing or HPV DNA Test | |
Average Cost | $24 to $150 | Around $30 |
Covered by Insurance? | Yes | Yes |
You cannot get infected by the same strain, but you can get an HPV infection twice if you get infected by 2 different HPV strains.
Yes, the virus can still be transmitted even if you do not have obvious symptoms.
When treating genital warts, it is essential to note that even though warts have cleared, there is a good chance that you might still be contagious. It might take around 3 to 6 months before the virus is entirely removed from your system.
Although rare, it is possible to get an infection from a hand carrying the virus, mainly when it previously contacted infected tissue.
No, HPV cannot survive long enough in fomites and inanimate surfaces.
Centers for Disease Control and Prevention
National Cancer Institute
American Society of Clinical Oncology
Written by Mark Riegel, MD
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