How Is the HPV Test Done?

HPV is one of the most common sexually transmitted infections in the world, affecting both women and men. Although it is often eliminated by the body without symptoms, some high-risk types, especially in women, can cause cervical cancer. At this point, the HPV test—one of modern medicine’s most important preventive tools—comes into play. This test detects the presence of high-risk HPV types that may cause cervical cancer, allowing for preventive action to be taken at a very early stage before cancer develops. So, how is this important HPV test performed?

What is HPV?

HPV is the name of a large virus family comprising more than 200 types that mostly infect the skin and mucous membranes. Each type of this virus has different characteristics and affects different parts of the body. HPVs are generally divided into two categories: low-risk and high-risk.

• Low-Risk HPV Types: These viruses generally do not cause cancer. Their most known effects are the formation of warts in the genital area, anus, mouth, or throat. HPV types 6 and 11 are responsible for about 90% of genital warts. Although these warts can be annoying, they do not pose a life-threatening condition.

• High-Risk HPV Types: This group includes the HPV types associated with cancer and is the primary cause of concern. Approximately 14 different high-risk HPV types have been identified. Among these, HPV 16 and HPV 18 are the most dangerous, as they are responsible for about 70% of all cervical cancers. High-risk HPV infections usually show no symptoms and are cleared by the immune system within one or two years. However, in some cases, the infection can become persistent. These long-term infections may cause abnormal changes in the infected area’s cells, leading to precancerous lesions and, if untreated, cancer. In addition to cervical cancer, high-risk HPV types can also cause cancers of the vulva, vagina, penis, anus, and oropharynx.

Due to the prevalence of HPV, almost everyone who is sexually active is likely to encounter the virus at some point in their lives. However, having the infection does not necessarily mean one will get cancer. With regular screening and HPV virus testing, risks can be managed and health can be protected.

How Is HPV DNA Testing Done?

The foundation of HPV screening is the HPV DNA test, the most reliable technique that searches for the genetic material of high-risk HPV types that can cause cervical cancer. Since this test detects the virus directly, it is more sensitive than the Pap smear test, which searches for cellular changes caused by the virus. So how is the HPV test performed? Although the process differs slightly between men and women, routine screening is primarily directed at women.

In women, the HPV test is usually a simple and painless procedure done during a gynecological examination. The process is very similar to how a Pap smear is collected, and both tests can often be done at the same time. To obtain the most accurate result, it is recommended to avoid vaginal douching, creams, suppositories, or medications, and abstain from sexual intercourse for 48 hours prior to the test. The test is generally not performed during menstruation; the ideal time is the week after the period ends.

The patient lies on a gynecological examination table. The doctor inserts a device called a speculum into the vagina to better visualize the cervix. Then, using a small, soft brush or spatula, a gentle sample of cells is taken from the surface and canal of the cervix. This procedure usually takes only a few seconds and causes no more than a mild pressure sensation.

The collected cell sample is placed in a special protective liquid inside a tube and sent to the laboratory. In the lab, DNA is isolated from the cells, and molecular techniques such as polymerase chain reaction (PCR) are used to detect high-risk HPV DNA. The test not only detects the presence of the virus but sometimes also identifies its type. While HPV testing and the Pap smear are often confused, they fundamentally look for different things: the HPV DNA test searches for the virus itself that can cause cancer, while the Pap smear analyzes under a microscope the abnormal, precancerous changes in cervical cells caused by the virus. The HPV test focuses on the cause; the Pap smear on the effect.

Current guidelines recommend that women over age 30 use either the HPV test alone or in combination with the Pap smear as the primary screening method.

What Does It Mean to Be HPV Positive?

Receiving a positive HPV test result can initially be alarming. However, rather than panicking, it’s important to understand what this means. A positive HPV result indicates that one or more high-risk HPV types associated with cancer have been detected in your body, particularly in the cervical region. This does not mean you have cancer. High-risk HPV infections are very common, and in most cases, the immune system clears the virus on its own within 6 months to 2 years without causing any problems.

A positive HPV result is simply a warning sign that your risk of cancer is increased and that you need closer monitoring. The course your doctor will follow after a positive result depends on your age, the specific HPV type identified in the test, and the result of the Pap smear taken at the same time.

Since HPV 16 and HPV 18 carry the highest cancer risk, your doctor will likely recommend a more detailed examination called colposcopy, even if your Pap smear result is normal. Colposcopy involves examining the cervix under magnification and taking a biopsy from suspicious areas.

If a high-risk HPV type other than 16/18 is detected and the Pap smear is normal, the doctor may recommend repeating the test after 12 months. If the follow-up test is still positive or abnormalities are detected in the Pap smear, you will be referred for colposcopy. If both the HPV DNA test and Pap smear reveal abnormalities, the risk is considered higher, and colposcopy becomes the standard approach for further evaluation.

What Does It Mean to Be HPV Negative?

A negative HPV test result is one of the best outcomes you can receive. It means that no DNA from high-risk HPV types was found in the tested sample. This indicates that your current risk of developing cervical cancer is very low. A negative result provides significant reassurance, as cervical cancer rarely develops without the presence of a high-risk HPV infection.

Thanks to the high reliability of the HPV test, women who receive a negative result can safely undergo screening at longer intervals. According to current national and international guidelines, for women who test negative using only an HPV test, the next screening is recommended after 5 years. If both HPV and Pap smear tests are negative, the interval is also generally 5 years. This approach reduces unnecessary worry, follow-up procedures, and costs.

However, it’s important to remember that a negative result is not a lifetime guarantee. Since HPV is sexually transmitted, future exposure from a new or current partner is still possible. Regardless of the result, it’s critical to follow your doctor’s recommended screening schedule. National programs such as KETEM HPV testing in Turkey also support regular screening.

What Causes HPV?

The shortest answer to this question is: HPV itself causes the infection. In other words, HPV is not a result but the cause of an infection. Once the virus enters the body, it settles inside cells and begins to replicate using the cell’s own systems.

• Transmission: The virus spreads through contact with the skin or mucosa of an infected person. This usually occurs during sexual activity.
• Cell entry: The virus generally reaches the basal cell layer through microscopic tears or abrasions in the skin or mucosa. Mucosal areas like the cervix, vagina, vulva, anus, and throat are particularly vulnerable.
• Replication: Once inside a cell, the virus integrates its DNA into the cell nucleus. From that point on, it hijacks the cell's normal division and reproduction mechanisms. Each time the cell divides, it also replicates the virus's DNA.
• Role of the immune system: A healthy immune system often detects this abnormal activity and eliminates infected cells, clearing the virus from the body. This explains why more than 90% of HPV infections disappear on their own within 1–2 years.
• Persistent infection: In some cases—especially with high-risk HPV types—the virus manages to evade the immune system and remain in the body for years. This is called a persistent infection.

In short, HPV is caused by the virus itself. The cancer risk arises from the persistent infection and the cellular disruptions it causes.

How Does HPV Spread?

Understanding how HPV is transmitted is crucial for developing protection strategies and reducing stigma around the virus. HPV is primarily transmitted through sexual contact, but the nature of this contact should be explained in detail.

Vaginal, anal, and oral sex are the most common routes of transmission. Any type of sexual contact involving the infected person’s genitals, mouth, or throat can transmit the virus to a partner. Full sexual intercourse is not necessary—the virus can be transmitted through skin-to-skin contact between the infected genital area and the partner’s skin or mucosa. Therefore, while condom use significantly reduces the risk, it does not provide 100% protection, as it does not cover all potentially infected areas.

Although rare, a woman with HPV can transmit the virus to her baby during childbirth. This can cause a condition in the baby called laryngeal papillomatosis, in which warts grow in the airway. However, this is a very rare complication.

HPV does not survive long on inanimate surfaces. Therefore, while transmission through items like toilet seats, towels, soap, or swimming pools is theoretically possible, it is considered negligible and not a primary mode of transmission.

What Is the HPV Vaccine?

The HPV vaccine is a preventive vaccine developed to protect against HPV infections and the cancers and warts these infections can cause. The vaccine does not contain live or weakened viruses. Instead, it includes virus-like particles (VLPs)—synthetic proteins that mimic the outer structure of the virus. The body perceives these VLPs as foreign and produces a strong antibody response. As a result, when a person is exposed to the actual HPV virus in the future, the immune system recognizes and neutralizes it before it can establish an infection.

Currently, the most widely used vaccine globally and in Turkey is Gardasil 9, which provides protection against nine different HPV types. The HPV vaccine is a primary prevention tool—its purpose is to prevent disease before it occurs. Screening tools like the HPV test are secondary prevention—they help detect the disease early after it has developed. Ideally, both methods should be used together.

When Should the HPV Vaccine Be Given?

For maximum benefit, the HPV vaccine should be administered before individuals become sexually active and are exposed to the virus. Therefore, the target group is adolescent girls and boys. The World Health Organization (WHO) and many national health authorities recommend routine vaccination of boys and girls between the ages of 9 and 14. In this age group, two doses are usually sufficient due to a stronger immune response.

Vaccination is also strongly recommended for girls and boys aged 15 to 16 who did not receive the vaccine earlier. In this age range, three doses are generally administered. The FDA has approved the HPV vaccine for individuals between the ages of 27 and 45 as well. However, the benefits may be more limited in this group, as they are more likely to have already encountered some HPV types in the past.

What Are the Benefits of the HPV Vaccine?

The HPV vaccine is one of the most important public health developments in recent years, and its benefits have been clearly proven by scientific studies.

• Cancer Prevention: The most significant benefit of the vaccine is that it substantially prevents HPV-related cancers. Gardasil 9 provides strong protection against approximately 90% of cervical cancers, 90–95% of anal cancers, 85% of vulvar cancers, 80% of vaginal cancers, and a significant portion of oropharyngeal cancers.
• Protection from Genital Warts: The vaccine targets HPV types 6 and 11, which are responsible for most genital warts, preventing the development of these troublesome and difficult-to-treat lesions by over 90%.
• Reduction of Precancerous Lesions: The vaccine significantly reduces the incidence of moderate to severe lesions in the cervix, vulva, and vagina that have the potential to turn into cancer.
• Decreased Need for Treatment and Costs: By preventing precancerous lesions and warts, the vaccine protects individuals from undergoing diagnostic and therapeutic procedures such as colposcopy, biopsy, and LEEP. This reduces both physical and psychological stress as well as healthcare costs.
• Herd Immunity: As vaccination rates reach a certain threshold in the population, the circulation of the virus decreases. This leads to indirect protection for unvaccinated individuals. Vaccinating males is also crucial for strengthening herd immunity and more effectively controlling the spread of the virus.

Frequently Asked Questions

Who Should Not Get the HPV Vaccine?

Although the HPV vaccine is extremely safe, there are certain situations in which it is not recommended. Individuals who have a known life-threatening allergy to the vaccine or any of its components should not receive it. Current data do not show that the vaccine harms the fetus during pregnancy, but as a precaution, HPV vaccination is not recommended during pregnancy. The vaccination series should be postponed until after childbirth. However, the vaccine is considered safe during breastfeeding. People experiencing high fever or a serious infection should wait until they recover before getting vaccinated. In mild cases like the common cold, vaccination does not need to be postponed.

Can Sexually Active Individuals Benefit from the HPV Vaccine?

Yes, absolutely. Being sexually active does not mean that a person won't benefit from the vaccine. The vaccine protects against 9 different HPV types, and even if a sexually active individual has been exposed to one or more of these types in the past, they can still benefit from protection against the remaining types. Therefore, it is recommended that everyone under age 26 who has not yet been vaccinated should receive the vaccine, regardless of their sexual activity. People between the ages of 27 and 45 should consult their doctor to evaluate their situation.

Is the HPV Vaccine Included in the Routine Immunization Schedule?

More than 120 countries worldwide have included the HPV vaccine in their national immunization schedules. In Turkey, the HPV vaccine is approved and licensed by the Ministry of Health; however, as of June 2025, it is not yet offered free of charge in the National Immunization Schedule. Access to the vaccine is currently possible only by purchasing it privately. Nonetheless, there is strong public demand and scientific support for including the HPV vaccine in the national program.

Where Can the HPV Vaccine Be Administered?

After being prescribed and obtained from a pharmacy, the HPV vaccine should be administered by a healthcare professional. You can consult your family physician, pediatrician, gynecologist, or infectious disease specialist to receive the vaccine. It is available at private hospitals, clinics, and medical centers. Those searching for “Where can I get an HPV test?” will often find that facilities offering the test also provide vaccination services.