HPV Positive: What It Means and What Happens Next

What exactly does a positive HPV test mean?

Human papillomavirus (HPV) is a group of over 200 related viruses, the majority of which are transmitted through skin-to-skin sexual contact. Most sexually active people will have HPV at some point in their lives.

HPV tests detect viral genetic material (DNA or RNA) in cervical cells. A positive result means HPV was detected at the time of the swab. It does not mean: - You will develop cancer - You have a sexually transmitted infection that requires treatment - Your current or past partners have been unfaithful (HPV can remain dormant for years)

The test typically distinguishes between high-risk types (most commonly HPV 16 and 18, which together are associated with the majority of cervical cancer cases) and low-risk types (most commonly 6 and 11, which can cause genital warts but are not associated with cervical cancer). Which types were found significantly shapes what follow-up care looks like 1Ref 1Meites E, Szilagyi PG, Chesson HW, Unger ER, Romero JR, Markowitz LE (2019).Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices.HPV vaccination recommendations for adults through age 26 and shared decision-making for ages 27–45.2Ref 2Perkins RB, Guido RS, Castle PE, et al. (2020).2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors.Risk-based management framework for abnormal cervical cancer screening, including HPV 16/18 genotyping and follow-up pathways..

What is the difference between high-risk and low-risk HPV?

Low-risk HPV types — including 6 and 11 — can cause genital warts but are not associated with cervical cancer. They do not require colposcopy or biopsy, though the warts themselves can be treated.

High-risk HPV types — of which HPV 16 and HPV 18 are the most common and clinically significant — can, over many years, cause cells on the cervix to develop abnormal changes (called dysplasia) that, if untreated, may progress to cervical cancer. The word "may" matters: persistent high-risk HPV infection increases risk, but most infections, even high-risk ones, are cleared by the immune system within one to two years without causing lasting cell changes.

HPV 16 and 18 together are associated with the great majority of HPV-related cervical cancers, which is why laboratory reports often flag these types separately 2Ref 2Perkins RB, Guido RS, Castle PE, et al. (2020).2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors.Risk-based management framework for abnormal cervical cancer screening, including HPV 16/18 genotyping and follow-up pathways..

What is the follow-up care after a positive HPV test?

Follow-up depends on what the HPV test found and whether it was done alongside a Pap smear (cervical cytology). Current U.S. guidelines from the American Society for Colposcopy and Cervical Pathology (ASCCP) use a risk-based approach — the next step is determined by the combination of HPV results, cytology findings, and relevant history 2Ref 2Perkins RB, Guido RS, Castle PE, et al. (2020).2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors.Risk-based management framework for abnormal cervical cancer screening, including HPV 16/18 genotyping and follow-up pathways..

Common scenarios:

• HPV positive, normal Pap (cytology negative): For most people, the recommendation is a repeat co-test (HPV + Pap) in one year, or primary HPV testing in one year, to see if the infection clears. If HPV 16 or 18 specifically are detected, colposcopy may be recommended sooner.
• HPV positive, abnormal Pap: Colposcopy is typically the next step — a procedure where a specialist examines the cervix more closely using a magnifying scope. Biopsies may be taken of any areas that look abnormal.
• HPV positive, cervical changes (CIN): If biopsy confirms cervical intraepithelial neoplasia (CIN 2 or higher), treatment to remove the abnormal cells is usually recommended.

Your gynecologist or OB-GYN will interpret your specific results in the context of your full screening history and determine the appropriate path 3Ref 3American College of Obstetricians and Gynecologists (2023).Colposcopy and Cervical Biopsies (Patient FAQ).Patient-facing description of colposcopy procedure and its role in HPV follow-up care..

What is a colposcopy, and what does it involve?

A colposcopy is an outpatient procedure, typically performed by a gynecologist, in which a lighted magnifying device (colposcope) is used to examine the cervix, vagina, and vulva more closely. A solution is applied to the cervix to highlight areas where cells may be abnormal.

If areas of concern are seen, the clinician takes a small tissue sample (biopsy) for laboratory analysis. This is what determines whether abnormal cells are present and, if so, how significant the changes are 3Ref 3American College of Obstetricians and Gynecologists (2023).Colposcopy and Cervical Biopsies (Patient FAQ).Patient-facing description of colposcopy procedure and its role in HPV follow-up care..

Colposcopy is not the same as treatment — it is a diagnostic step. Many people have a colposcopy and are told the cells look fine, or show only mild changes that resolve on their own.

Is there a treatment for HPV itself?

There is no antiviral treatment that clears HPV itself. The immune system is the primary mechanism by which most infections resolve. What can be treated are the problems HPV causes: genital warts (with topical treatments or procedures) and precancerous cervical changes (with procedures like LEEP or cryotherapy to remove affected tissue).

The most effective prevention against HPV-related cancer and disease remains the HPV vaccine. The ACIP recommends vaccination for people through age 26, and shared decision-making for adults 27–45 who may benefit based on their risk 1Ref 1Meites E, Szilagyi PG, Chesson HW, Unger ER, Romero JR, Markowitz LE (2019).Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices.HPV vaccination recommendations for adults through age 26 and shared decision-making for ages 27–45.. Vaccination is effective even for people who have already been exposed to HPV, because most people are not infected with all high-risk types, and the vaccine can protect against types not yet encountered.

Who should be involved in my follow-up care?

For a positive HPV test, the appropriate specialist is a gynecologist or OB-GYN, who is trained in cervical cancer screening management, colposcopy, and gynecologic oncology referrals if needed. A primary care clinician may be the one who orders the initial screening test and can help interpret results, but the follow-up management — especially if colposcopy is needed — sits with a gynecologist.

Gale can help you understand your results, identify questions to bring to your specialist, and coordinate your care. The actual colposcopy and biopsy procedures, and decisions about treatment for any cervical cell changes, should be carried out by your gynecologist.