HPV test
Looks for
High-risk types of human papillomavirus (HPV) associated with cervical cell changes.
What it tells us
A positive result identifies a need for further assessment or surveillance. It does not by itself show that cancer is present.
Screening, HPV & your results
Cervical screening
Screening looks for HPV and treatable cell changes before cancer develops. Understand why we test, how the results fit together, and where follow-up can make a difference.
An abnormal screening result is not a diagnosis of cancer. It means the result needs a clear follow-up plan.
Enlarge anatomy (new tab)
01 / Understanding HPV
A common virus with different types.
Human papillomavirus (HPV) is a family of viruses that infect skin and moist surfaces such as the cervix. Some types cause warts. Other, “high-risk” types can cause cell changes if the infection persists. HPV 16 and 18 are particularly important high-risk types. HPV is a different virus from HIV or herpes.
Genital HPV is passed through intimate skin-to-skin contact, including vaginal, anal or oral sex and genital contact without penetration. It can be passed on without symptoms. Condoms reduce risk but do not cover all skin that can carry HPV.
Can HPV pass on during non-penetrative sex?
Yes. Genital skin-to-skin contact can transmit HPV without penetrative intercourse. Oral sex and sharing sex toys can also involve exposure. “I have not had penetrative sex” does not necessarily mean “I have never been exposed to HPV”.
Source: NHS: how HPV is passed on.
Can I get HPV from using tampons?
Ordinary use of a new tampon is not an established route of acquiring genital HPV. HPV is mainly passed through intimate contact with infected skin or mucosa. A positive result cannot identify how or when an individual acquired it.
You may read about tampons used to collect HPV samples. Those tests detect virus already present in the sample; they do not show that the tampon caused the infection.
Context: CDC: established transmission routes and South African research on tampon-based sample collection.
A positive result cannot date the infection or identify a partner. It is not evidence of infidelity. We manage the finding and any cell changes without blame.
Further reading: CDC: genital HPV and HPV counselling and transmission.
02 / Why screening matters
There is an opportunity to act before cancer.
Most HPV infections are controlled by the immune system and become undetectable, often within one or two years. Persistent high-risk infection can sometimes cause precancerous changes. These may take years to develop and usually cause no symptoms.
Screening finds the people who need a closer look. Colposcopy and, where indicated, biopsy clarify what is happening. Treating significant precancer can prevent it becoming invasive cancer. Not every infection causes cell changes, and not every cell change becomes cancer.
Background: WHO: cervical cancer prevention. The pathway below illustrates risk-based follow-up rather than a single rule for every positive test.
03 / The opportunity to prevent cancer
Screening creates opportunities to prevent cervical cancer.
Cervical cancer often develops over many years. Screening can find precancerous changes before symptoms appear, and timely treatment can prevent them becoming cancer.
Usually slow—but the pace varies.
Some changes progress more quickly. A first positive HPV test does not tell us when the infection began, so it does not start a new countdown. Follow-up depends on your results and history.
The sequence below shows one possible course. Most HPV infections never lead to cancer.
Starting pointHPV exposure
High-risk HPV
The virus infects cervical cells, usually without symptoms. A test cannot tell when it was acquired.
If HPV remainsPersistent infection
Changes may develop
Persistent high-risk infection can cause cell changes. Some changes regress; others persist or become more significant.
Changes may still cause no symptoms.
↳ Screening can identify riskChanges within the liningPrecancerous changes
Still within the lining
Significant abnormal cells are still contained within the surface lining. Finding and treating them can prevent invasive cancer.
This is an important opportunity to act.
↳ Treatment can interrupt hereIf changes invade deeperPossible invasive cancer
Beyond the surface lining
If significant precancer is missed or left untreated, some lesions can invade deeper tissue. Progression is not inevitable.
If cancer is found →
Abnormal cells Boundary beneath the surface lining Simplified tissue views; not to scale.
A different course is possible
Screen. Assess. Treat when needed. Keep checking.
Your screening plan follows the ages and intervals appropriate for you. An abnormal result may need much earlier follow-up, assessment or treatment.
Identify risk
HPV testing and cytology can find risk or cell changes before symptoms appear.
The screening tests →Look more closely
Colposcopy and, when needed, biopsy establish which changes need monitoring or treatment.
Colposcopy explained →Remove significant precancer
Treatment such as LLETZ can interrupt the pathway to cancer while the changes are still localised.
See how LLETZ works →Stay in follow-up
The tissue report, healing and later HPV-based tests guide continued care. Treatment does not guarantee HPV clearance.
Know your results →
The aim: prevent cancer by finding and treating precancer in time. Screening and treatment reduce risk; keeping the follow-up plan matters.
Keep your recommended follow-up. Changes can develop faster, particularly with immune suppression. Significant precancer or cancer can already be present at a first assessment. Do not delay an advised test, treatment or symptom assessment because this process is often slow.
How long can these changes take?
Research describes a process that often unfolds over years to decades. The National Cancer Institute gives broad estimates of 5–10 years from HPV infection to precancer and about 20 years from infection to cancer. These figures describe a possible long course; they are not minimum times, safe waiting periods or a prediction for you.
Progression can be faster, particularly with a weakened immune system. We usually cannot establish when an infection began. Your HPV type, cell or tissue findings, previous results and health determine what happens next.
Timeframes and prevention: NCI: HPV and cancer · WHO: cervical cancer prevention.
Where do HPV 16/18, NILM, LSIL, HSIL and AIS fit?
The screening report
NILM means no abnormal cells were identified in that sample. HPV 16 or 18 with NILM still warrants colposcopy in risk-based guidance; a normal-looking cell sample does not cancel out the HPV result.
LSIL describes low-grade cell changes and HSIL describes high-grade changes. HPV type, earlier results and any colposcopy or biopsy findings determine the next step. A reassuring assessment may lead to a repeat test at an agreed interval; a high-grade result needs prompt assessment.
What tissue sampling can show
CIN means cervical intraepithelial neoplasia: CIN 1 is low-grade; CIN 2 and 3 are high-grade. Significant high-grade disease often needs treatment; selected CIN 2 can be monitored carefully in appropriate circumstances.
AIS, or adenocarcinoma in situ, is a separate glandular precancer in the cervical canal. It is not the next stage after HSIL. Excision helps assess its extent and exclude invasion; further treatment depends on the findings and pregnancy plans.
Clinical basis: ASCCP risk-based management · NCI: abnormal result terms · ASCCP: AIS (PDF).
04 / Understanding the tests
HPV and Pap tests look for different things.
Screening aims to find risk or early cell changes before cancer develops. HPV testing, a Pap smear or a combination may be used, depending on the screening plan.
A screening sample is not a full sexually transmitted infection screen and does not check for ovarian or uterine cancer. No screening test detects every problem.
Further reading: ACOG: cervical screening.
05 / Your screening plan
Know when to start, repeat and review.
In this practice, the routine approach below applies to someone with a cervix, no symptoms and average risk. It follows an international screening guideline suited to high-resource care. Dr Adlam adapts the plan to your previous results, treatment and immune health.
Starting
From age 25
Routine screening generally starts at 25. Symptoms or particular risks need assessment at any age.
If results stay normal
Every 3–5 years
Usually every 5 years after a negative clinician-collected HPV test or normal co-test; every 3 years with Pap testing alone.
Considering stopping
Review at 65
Stopping depends on adequate documented normal screening and the absence of a reason for continued surveillance. It is not automatic on a birthday.
These are routine screening intervals, not the follow-up plan for an abnormal result. A consultation or assessment of symptoms may be needed between screening tests. Vaccination and menopause do not remove the need for age-appropriate screening.
What counts as enough normal screening before stopping?
Review the records together. With the approach above, this generally means two consecutive negative HPV-based screens at the recommended intervals, or three normal Pap-only screens at the recommended intervals, with a recent normal result before stopping at or after 65. If records are missing or screening has been irregular, continue until the stopping criteria are met.
Previous abnormalities may change this. After treatment of high-grade precancer (CIN 2, CIN 3 or AIS), surveillance generally continues for at least 25 years, even beyond 65. A history of cervical cancer requires a specialist follow-up plan.
Sources: ACS: stopping criteria and CDC: surveillance after high-grade precancer.
Do I still need screening after a hysterectomy?
- Cervix still present: continue cervical screening. A subtotal or supracervical hysterectomy leaves the cervix behind.
- Uterus and cervix removed for a benign condition, with no history of significant cervical precancer or cancer: routine cervical screening is usually no longer needed.
- Previous high-grade precancer or cancer: continued surveillance may include samples from the top of the vagina, even after the cervix has been removed.
Bring the operation and pathology reports if you are unsure. Whether the ovaries were removed is not what determines the need for cervical screening. New bleeding, discharge or pain still deserves assessment.
Sources: NCI: screening after hysterectomy and CDC: continued surveillance.
Do I need screening if I have never had sex?
Someone who has never had any sexual contact has a much lower risk of genital HPV. However, penetrative intercourse is not required for transmission, and the word “virgin” does not reliably describe HPV exposure. Routine age-based recommendations still offer screening; discuss your actual history, likely benefit, comfort and preferences before deciding.
An examination always requires consent. Tell us if an internal examination is unfamiliar or difficult so we can discuss a gentle approach or suitable alternatives. Symptoms should be assessed regardless of sexual history.
Further reading: NHS: sexual history and screening.
Reference for the routine schedule: American Cancer Society screening guidance. South African programme recommendations differ in some starting, interval and stopping criteria: SASOG/BetterGyn guidance (PDF). Your individual plan should be recorded clearly.
06 / The appointment
You stay in control.
For a clinician-collected sample, a speculum is gently placed in the vagina so the cervix can be seen. A small brush collects the sample, which is sent to a laboratory. Tell the clinician if you are pregnant or may be pregnant.
Explain any previous pain, difficult examination, anxiety or trauma. You can ask for a chaperone, discuss a smaller speculum or a different position, and ask to pause or stop at any point. An examination should not continue without your consent.
Ask for preparation instructions when booking, especially if you are using vaginal treatment or expect your period. If bleeding is the reason you are seeking care, describe that symptom rather than simply delaying the appointment.
Light spotting can happen after sampling. Contact the practice if bleeding persists or is heavier than expected; severe pain or feeling faint needs urgent assessment.
Is a Pap smear or HPV sample safe during pregnancy?
Yes. A cervical screening sample can be taken safely during pregnancy when due or clinically indicated; screening has not been linked to an increased miscarriage rate. The sample is taken from the cervix. Tell us that you are pregnant so we use an appropriate sampling technique. The cervix can bleed more easily, so light spotting may follow.
We review whether to test during pregnancy or defer a routine screen until after birth, considering your history and local care plan. Pregnancy is not a reason to ignore an abnormal result or unexplained bleeding. Colposcopy, and biopsy when indicated, can be performed in pregnancy; treatment of precancer is usually deferred, while suspected cancer needs specialist assessment.
Sources: Cancer Council: screening in pregnancy and ASCCP: abnormal results in pregnancy.
What to expect: NHS: the screening appointment.
07 / Making sense of a result
The next step depends on the whole report.
The terms below are a guide, not an automatic treatment decision. HPV type, cell findings, previous results and immune health are considered together.
Further reading: NHS: screening result terms and ACOG: abnormal results. Follow-up timing is personalised to the local care pathway.
08 / What you can do
HPV positive? Make a plan, then keep it.
A positive HPV test is common and does not mean you have cancer. The useful next step is to understand the result and arrange the follow-up it calls for.
Clarify your next appointment.
Ask which HPV type was detected, whether cell testing was normal, and whether you need repeat testing or colposcopy. Some results need prompt assessment; others can be monitored. Keep a copy of the report and a reminder for the agreed date.
There is no medicine that reliably clears HPV.
We monitor the infection and treat significant cell changes when indicated. Antibiotics do not clear HPV. Do not replace follow-up with a supplement, “immune booster” or vaginal product marketed as a cure.
What else can I do to reduce risk?
Keep screening and follow-up appointments, discuss HPV vaccination, and use condoms or barriers to reduce exposure, recognising that they cannot cover every area of genital skin. Limiting new sexual partners reduces opportunities for new infection; HPV can nevertheless occur with a single partner.
If you live with HIV, maintain your HIV care and prescribed treatment. Tell us about other causes of reduced immunity. General health measures are worthwhile, but a positive result is not a personal failure or proof of an unhealthy lifestyle.
Does my partner need testing or treatment?
Partners often share HPV, and the result cannot establish when it was acquired or from whom. Routine HPV testing of a male partner is not recommended. A partner with a cervix should keep their own screening schedule; anyone with a visible lesion or symptoms should seek assessment. There is no treatment to give both partners simply to clear an asymptomatic HPV result.
Sources: CDC: treatment, partners and tobacco counselling, NCI: understanding an abnormal result and NHS: HPV prevention and treatment.
09 / Assessment & treatment
Colposcopy and LLETZ do different jobs.
Colposcopy: look closely and, if needed, sample.
A speculum allows the cervix to be seen. A magnifying instrument stays outside the body, and liquids help identify areas that need attention. A small biopsy or a sample from the cervical canal may be taken. This helps distinguish a low-grade change, significant precancer and possible cancer.
LLETZ: remove an area for treatment and diagnosis.
Large loop excision of the transformation zone (also called LEEP) uses a fine heated wire loop to remove an area of the cervix. The tissue goes to the laboratory to assess the type and extent of the changes and the cut edges. It can treat precancer while also checking for disease that a smaller sample might miss.
Dr Adlam performs both procedures. Colposcopy does not automatically mean a biopsy or treatment, and an abnormal screening result does not automatically mean you need LLETZ. Dr Adlam performs LLETZ under general anaesthesia. We discuss the reason for treatment and the theatre and anaesthetic arrangements beforehand. Follow the team's fasting, medicine and transport instructions.
After treatment, the tissue result and follow-up tests matter. Removing abnormal tissue does not guarantee HPV has disappeared. HPV-based surveillance continues, often for many years after high-grade disease.
Further reading: NHS: colposcopy and ACOG: cervical cell changes and treatment.
A closer look / LLETZ
Remove the precancer. Preserve the rest of the cervix.
LLETZ uses a fine wire loop carrying an electrical current to remove the selected area. The purpose is to treat precancer and obtain tissue for diagnosis. In Dr Adlam's practice, LLETZ is performed under general anaesthesia. The reason and extent of treatment are discussed beforehand.
01 / Locate
Identify the area that needs treatment.
Colposcopy assesses the cervix. Many changes arise in the transformation zone, where different cell types meet. The illustrated patch marks an area requiring assessment.
The location and size of this zone vary; colour alone does not diagnose a lesion.
Enlarge view (new tab)02 / Remove
A shaped piece of tissue is removed.
The loop removes the selected tissue, including the area of concern. The cut surface is treated to control bleeding. The rest of the cervix remains in place.
The depth and amount removed are individual. This separated view explains the principle, not a standard size or surgical technique.
Enlarge cutaway (new tab)03 / Check & follow up
The tissue result guides what happens next.
The laboratory checks the changes, their extent and the tissue edges. We review the result, recovery and the schedule for HPV-based surveillance. Further assessment or treatment may be needed.
Healing and removal of the lesion do not guarantee that HPV has cleared.
Enlarge follow-up view (new tab)Procedure information: RCOG: LLETZ. Original simplified illustrations; colours and proportions are explanatory.
10 / Prevention
Vaccination and screening work together.
HPV vaccines train the immune system to recognise selected HPV types before infection. They use non-infectious virus-like particles and cannot cause HPV infection.
What do the vaccines cover?
All established cervical-cancer HPV vaccines cover types 16 and 18. Bivalent vaccines cover these two types; quadrivalent vaccines also cover wart-associated types 6 and 11. The nine-valent vaccine, Gardasil 9, adds five further high-risk types: 31, 33, 45, 52 and 58.
Dr Adlam's practice has access to HPV vaccines, including Cervarix and Gardasil 9. We choose a suitable product with you. A broader vaccine still does not cover every cancer-causing HPV type.
Who should consider vaccination?
Protection is greatest before exposure, which is why vaccination is offered in childhood and adolescence. Catch-up vaccination and vaccination of adults are individual discussions based on age, previous doses, likely future exposure and the locally licensed product.
A previous HPV infection does not mean you have encountered every vaccine type. Vaccination may still offer protection against types you have not acquired.
Cervarix
About R1,000 per dose
A bivalent vaccine targeting high-risk HPV types 16 and 18. It is aimed at preventing HPV-related precancer and cancer; it does not target the main genital-wart types.
Gardasil 9
About R2,000 per dose
Targets seven cancer-associated HPV types and types 6 and 11, which cause most genital warts. It offers broader type coverage.
Approximate practice prices supplied September 2026, per injection. The full course cost depends on the number of doses. Confirm the current total with reception, including whether consultation or administration charges apply and any medical-aid benefit.
How many doses are needed?
The course depends on age at the first dose, immune health, previous vaccination and the product used. Private-care courses may use two or three doses. South Africa's school programme uses a single-dose approach for its eligible population; that is not a universal schedule for every adult or person living with HIV. We confirm the appropriate course and dates individually.
Does it treat HPV or replace my next test?
No. Vaccination prevents new infections with covered types; it does not clear an existing infection or treat established precancer. Keep any screening, colposcopy or post-treatment follow-up already arranged.
What about safety and pregnancy?
HPV vaccines have a well-established safety record. A sore arm, headache or brief faintness can occur; severe allergic reactions are rare. Tell the clinician about previous vaccine reactions and pregnancy. HPV vaccination is generally deferred during pregnancy, with remaining doses planned afterwards.
Sources: SAHPRA: Cervarix patient information (PDF) · SAHPRA: Gardasil 9 product information (PDF) · South African single-dose programme recommendation (PDF) · CDC: HPV vaccine safety.
11 / If cancer is diagnosed
A specialist team plans the next step.
A screening result alone does not diagnose cancer. If tissue sampling shows invasive cancer, prompt referral to a gynaecological oncology team is needed. Examination, review of the biopsy and appropriate imaging establish the type and stage.
Some early cancers can be treated surgically. Carefully selected small cancers may allow fertility-preserving treatment; this needs specialist assessment. Other stages are commonly treated with radiotherapy and chemotherapy, including internal radiotherapy called brachytherapy. Advanced or recurrent disease may involve systemic treatments such as chemotherapy, targeted treatment or immunotherapy when appropriate.
Treatment depends on the stage, tumour features, health and personal priorities. Discuss fertility before treatment if it matters to you, and ask for help with symptoms, sexual health, emotional support and costs. An early conversation makes room for these needs while the team coordinates care.
Further reading: NCI: diagnosis and cervical cancer treatment by stage.
12 / Common questions
Less uncertainty, clearer follow-up.
Does HPV mean a partner has been unfaithful?
No. HPV can be detected many years after exposure. A positive result cannot establish when it was acquired or from whom.
Can I have symptoms with a normal result?
Yes. A screening result does not explain every cause of bleeding, discharge or pain. Arrange an assessment for new or persistent symptoms even if your most recent screen was normal.
Can I still ask about HPV vaccination?
Yes. Discuss your age, previous doses and immune health to see whether vaccination is appropriate. It prevents new infections with covered HPV types; it does not treat an existing infection or replace follow-up.
What should I bring if another practice did my test?
Bring the full laboratory report, dates of previous tests, and any colposcopy, biopsy or treatment reports. The exact findings are more useful than being told only that a result was “abnormal”.
Know your result. Know your next step.
Book screening or a consultation to discuss an existing report.
Sources reviewed 26 September 2026. References are linked beside the relevant sections. The routine schedule reflects the approach selected for this practice. International and South African guidance inform care; your results and history determine individual follow-up.