Lab result explainedInflammationLast updated November 11, 2026

HPV test: what a positive high-risk HPV, HPV 16 or HPV 18 result means, and HPV test vs Pap smear

HPV test · Cervical cancer screening (primary HPV test, or HPV/Pap co-test) · reported in Qualitative: negative, or positive for high-risk HPV, with HPV 16 and HPV 18 (or 18/45) reported individually and the remaining 12 types pooled as 'other high-risk HPV' on most assays

An HPV test looks for the genetic material of high-risk types of human papillomavirus in cells taken from the cervix, usually from the same sample as a Pap smear. The 14 types it detects (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68) are the ones that can, over many years, cause cervical cancer; types 16 and 18 alone account for about 70 percent of cases, which is why most tests report them separately. The result is negative, or positive for HPV 16, HPV 18 (or 18/45), or 'other high-risk HPV'.

A positive HPV test is extremely common and is not a diagnosis of cancer or even of precancer. About 8 in 10 sexually active people acquire HPV at some point, roughly 1 in 4 women under 30 test positive at any given time, and about 90 percent of infections are cleared by the immune system within two years without any treatment. What matters is persistence: an infection that is still there a year or two later, especially with type 16 or 18, is what raises the risk of the precancerous changes (CIN 2 and CIN 3) that screening is designed to find and treat before cancer develops, a process that typically takes 10 to 20 years.

In the United States, HPV testing is recommended from age 30 (US Preventive Services Task Force) or 25 (American Cancer Society) through 65, either alone every 5 years, together with a Pap smear every 5 years (co-testing), or a Pap alone every 3 years. The HPV test detects more precancer than the Pap smear (around 90 to 95 percent of CIN 2 or worse on a single test, compared with 50 to 80 percent for cytology), which is why a negative HPV result earns a 5-year interval. What happens after a positive result depends on the type, your Pap result and your previous screening history, following the 2019 ASCCP risk-based guidelines.

HPV test at a glance

What it is: a laboratory test for the DNA or RNA of 14 cancer-causing (high-risk) HPV types in cervical cells; it does not detect the low-risk types that cause genital warts, and it is not a test for cancer.
Normal: negative for high-risk HPV. Your 5-year risk of serious precancer is around 0.1 to 0.3 percent, so routine screening repeats in 5 years between ages 30 and 65.
Positive for 'other high-risk HPV' with a normal Pap: repeat HPV testing or co-testing in 12 months; about half will have cleared by then, and colposcopy is only needed if it is still positive or the Pap becomes abnormal.
Positive for HPV 16 or HPV 18: colposcopy is recommended regardless of the Pap result, because the immediate risk of CIN 3 or worse is above the 4 percent threshold (about 5 percent for HPV 16 with a normal Pap, far higher with an abnormal one).
HPV test vs Pap smear: the HPV test finds the cause, the Pap finds the cell changes. HPV testing is more sensitive and a negative result lasts longer; the Pap is still used to decide what to do when HPV is positive.
Next step: do not panic and do not skip follow-up. Most positives clear; the follow-up visit (repeat test or colposcopy) is where precancer is caught, and treating it at that stage prevents cancer in more than 90 percent of cases.

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What HPV test measures

Cells are collected from the cervix with a small brush and placed in a liquid-based cytology vial; the same vial is used for the Pap smear, so one visit covers both. The laboratory extracts nucleic acid and runs a PCR-based assay for HPV DNA (cobas, BD Onclarity) or an assay for the E6/E7 messenger RNA the virus makes when it is actively driving cell growth (Aptima). Most assays report HPV 16 and HPV 18 individually and the remaining 12 types as a pooled 'other high-risk' result; extended-genotyping tests also separate 31, 33, 45, 52 and 58, which carry intermediate risk.

The test is built for screening sensitivity, not for diagnosing cancer: it detects the virus whether or not it has caused any cell change, which is why a positive result is so common and why it is paired with cytology or colposcopy to see whether the cervix has actually been affected. Self-collected vaginal swabs, which the FDA approved for use in health-care settings in 2024 and for at-home collection in 2025, perform almost as well as clinician-collected samples when a PCR-based test is used, with sensitivity for CIN 2 or worse within a few percentage points.

There is no FDA-approved HPV test for men, for the throat or for the penis, and routine HPV testing of the anus is reserved for people at high risk of anal cancer, such as people living with HIV. Blood tests cannot detect HPV infection. The test also does not detect the low-risk types 6 and 11 that cause genital warts, so a negative HPV test does not rule out warts, and having warts does not mean a high-risk type is present.

Normal range for HPV test

Reference ranges vary between labs and by age, sex and pregnancy. Use the range printed on your own report.

Group	Typical range (Qualitative: negative, or positive for high-risk HPV, with HPV 16 and HPV 18 (or 18/45) reported individually and the remaining 12 types pooled as 'other high-risk HPV' on most assays)	Notes
Negative for high-risk HPV (age 30–65)	Not detected	5-year risk of CIN 3 or worse about 0.1 to 0.3 percent. Routine screening repeats in 5 years with primary HPV testing or co-testing. Assays differ slightly in which types are included.
Negative HPV with a mildly abnormal Pap (ASC-US)	HPV not detected, cytology ASC-US	Low risk; return to routine screening in 3 years under the 2019 ASCCP guidelines. A negative HPV result with LSIL or a higher-grade Pap still needs follow-up based on the cytology.
Positive, other high-risk types (not 16/18), Pap normal	Detected	Immediate CIN 3+ risk about 2 percent; repeat HPV test or co-test in 12 months. Colposcopy if still positive at the repeat or if the Pap becomes ASC-US or worse.
Positive HPV 16, any Pap result	Detected	Colposcopy. HPV 16 causes about 55 to 60 percent of cervical cancers and persists longer than other types; immediate CIN 3+ risk is around 5 percent with a normal Pap and 20 to 60 percent with HSIL.
Positive HPV 18 (or 18/45), any Pap result	Detected	Colposcopy. HPV 18 is linked to adenocarcinoma, which arises higher in the cervical canal and is more often missed by the Pap smear, so a normal Pap is less reassuring with this type.
Positive, any high-risk type, with ASC-US or LSIL	Detected	Colposcopy (immediate CIN 3+ risk about 4 percent). If an HPV test in the previous 5 years was negative, repeat testing in 1 year may be offered instead.
Positive, any high-risk type, with ASC-H or HSIL	Detected	Colposcopy, and for HSIL in people 25 and over, treatment without waiting for a biopsy result (expedited treatment) is acceptable because immediate CIN 3+ risk is 25 to 60 percent.
Positive under age 25 (under 30 by USPSTF)	Detected	HPV testing is not recommended as the primary screen in this age group because transient infection is so common (positivity 25 to 35 percent). If done, management favors repeat testing over colposcopy.
Unsatisfactory, invalid or insufficient	No result	Usually too few cells or an assay failure; repeat in 2 to 4 months. Not a positive and not a negative.

Positive HPV test

A positive HPV test means the DNA or RNA of at least one high-risk HPV type was found in the cells from your cervix. In the great majority of cases this is a transient infection that your immune system will clear: roughly half of positives are negative a year later and about 90 percent within two years. The test cannot tell you when you acquired the infection, which may have been weeks or decades ago, because HPV can lie dormant for years and reactivate, particularly around menopause or with a weakened immune system. A positive result therefore says nothing about a partner's recent behavior.

The type and the Pap result together set the next step. Positive for 'other high-risk' types with a normal Pap is the most common combination; the immediate risk of serious precancer is about 2 percent, so the guideline is a repeat test in 12 months rather than colposcopy. Positive for HPV 16 or 18, or positive for any type alongside an abnormal Pap, carries an immediate CIN 3+ risk at or above 4 percent, the threshold at which colposcopy (a magnified examination with small biopsies) is recommended. A positive HPV test with a normal Pap is not a reason for treatment of any kind; treatment is only for CIN 2 or CIN 3 confirmed on biopsy.

The reason any of this matters is persistence. In a large US cohort, women positive for HPV 16 had a 10-year cumulative risk of CIN 3 or cancer of about 17 percent, those positive for HPV 18 about 14 percent, those positive for the other high-risk types about 3 percent, and those who tested negative under 1 percent. Found at the CIN 2 or 3 stage, a short office procedure (LEEP or cone biopsy) removes the affected tissue and prevents progression in more than 90 percent of cases. Cervical cancer develops almost exclusively in people who were never screened or who did not get follow-up after an abnormal result.

Common causes

Recent or current infection with a high-risk HPV type
Acquired through skin-to-skin genital contact, including oral and manual contact; condoms reduce but do not eliminate transmission. Most new infections occur within a few years of becoming sexually active and in the months after a new partner.
Reactivation of a latent infection acquired years earlier
HPV can persist at undetectable levels in basal cells for decades. A second peak of positivity in women over 45 to 50, often with no new partner, is thought to reflect reactivation as immune surveillance declines with age and menopause.
Persistent infection, especially with HPV 16 or 18
The minority of infections still detectable 12 to 24 months later. Persistence is the real risk factor; type 16 persists longest and causes the most disease.
Smoking
Current smokers are about twice as likely as never-smokers to have persistent HPV and to develop CIN 2 or 3, in a dose-dependent fashion; tobacco carcinogens concentrate in cervical mucus and impair local immunity.
Weakened immunity: HIV, transplant medicines, long-term steroids, biologics
People living with HIV have higher HPV positivity, slower clearance and a 3 to 6 times higher cervical cancer risk; screening starts earlier, is annual to begin with and continues beyond 65.
Hormonal factors: long-term combined pill use and multiple full-term pregnancies
Both are associated with modestly higher persistence and CIN risk (relative risk around 1.5 to 2 after 5 or more years of pill use), through hormonal effects on the cervical transformation zone rather than through changing exposure.
Co-infections and the vaginal microbiome
Chlamydia and bacterial vaginosis are associated with slower HPV clearance, while a Lactobacillus-dominant vaginal flora is associated with faster clearance in cohort studies.
Cross-reaction or sampling artifact
Uncommon with PCR-based assays. Older hybrid-capture tests sometimes cross-reacted with low-risk types; blood or lubricant in the sample more often causes an invalid result than a false positive. A positive HPV test is almost always virologically real.

Symptoms that can go with it

None: HPV infection and cervical precancer cause no symptoms, which is why screening exists
Bleeding after sex, between periods or after menopause, which is never attributed to HPV alone and needs examination
Persistent watery, bloody or foul-smelling vaginal discharge
Pelvic or low back pain, pain during sex or leg swelling, which occur only with advanced cervical cancer
Genital warts, which are caused by low-risk types 6 and 11 that this test does not detect; having them does not mean a high-risk type is present
No symptoms in partners either; HPV cannot be seen, felt or routinely tested for in men

Negative HPV test

A negative high-risk HPV test is one of the most reassuring results in preventive medicine. Because almost all cervical cancer is caused by the 14 types the test detects, and because precancer takes years to develop, a negative result means your risk of CIN 3 or cancer over the next 5 years is around 0.1 to 0.3 percent, lower than the risk 3 years after a normal Pap smear. That is why guidelines extend the screening interval to 5 years after a negative HPV test or co-test, and why screening can stop at 65 after two consecutive negative HPV tests or co-tests in the previous 10 years.

Negative does not mean you have never had HPV; most adults have had and cleared it. It does not cover the low-risk wart types, HPV at other sites (throat, anus) or the rarer high-risk types not on the panel, and a very recent infection can be below the detection threshold. A negative HPV test with an abnormal Pap is handled according to the Pap result: ASC-US returns to routine screening in 3 years, while LSIL, ASC-H or HSIL still need follow-up or colposcopy.

Common causes

No current infection, or an infection that has been cleared
The expected result in about 90 percent of women over 30. Clearance means the virus is no longer detectable; whether it is eliminated or simply suppressed to undetectable levels is still debated, which is why late reactivation is possible.
Infection with a type not on the panel
Types such as 26, 53, 69, 73 and 82 are classed as possibly carcinogenic and are not included in most assays; they cause a very small share of cancers.
Viral load below the assay's detection limit
Very early or resolving infection, or a lesion high in the canal that sheds few cells. This is one reason a negative HPV test with HSIL cytology still goes to colposcopy.
Poor sample
Too few cervical cells, heavy blood, or recent treatment (LEEP within 3 months) reduce yield; assays include an internal human-DNA control to flag an inadequate sample as invalid rather than negative.

Symptoms that can go with it

None; a negative result causes no symptoms
Bleeding after sex or after menopause still needs examination even with a negative HPV test, since a small number of cervical and other gynecologic cancers are HPV-negative

Read it alongside

Pap smear (cervical cytology) — shows whether the virus has produced cell changes (ASC-US, LSIL, ASC-H, HSIL); with the HPV type it determines whether you need a repeat test or colposcopy.
HPV genotype (16, 18/45, extended genotyping) — HPV 16 and 18 carry the highest risk and go straight to colposcopy; extended genotyping (31, 33, 45, 52, 58) refines risk further.
Colposcopy with biopsy (CIN 1, 2, 3) — the actual diagnosis of precancer; CIN 1 is observed, CIN 2 and 3 are usually treated.
p16/Ki-67 dual-stain cytology — FDA-approved in 2020 to triage HPV-positive results; a negative dual stain lowers immediate CIN 3+ risk enough to defer colposcopy in some cases.
HIV test — HIV changes HPV clearance and the screening schedule, and new cervical precancer is an indication to test for HIV.
Chlamydia and gonorrhea NAAT — often collected at the same visit; chlamydia co-infection is associated with HPV persistence.
Pregnancy test (hCG) — colposcopy is safe in pregnancy, but biopsies and treatment are limited, so pregnancy status changes timing.
Anal cytology and anal HPV testing — recommended for people living with HIV and others at high risk of anal cancer, where the same high-risk types act.

What usually happens next

Find out exactly what was reported: HPV 16, HPV 18, 'other high-risk' or negative, and what the Pap showed. The combination, plus your previous results, determines everything that follows under the 2019 ASCCP guidelines.
'Other high-risk' positive with a normal Pap: a repeat HPV test or co-test in 12 months. If it is negative then, you return to routine screening (with a repeat at 3 years rather than 5); if still positive, colposcopy.
HPV 16 or 18, or any positive with an abnormal Pap: colposcopy, usually scheduled within 3 months. Biopsies take 1 to 2 weeks to report; CIN 1 is watched, CIN 2 or 3 is treated with LEEP or a cone biopsy.
After treatment for CIN 2 or 3, an HPV test at 6 months and then yearly for 3 years detects the roughly 5 to 10 percent of residual or recurrent disease; a negative HPV test after treatment is strongly reassuring.
Ask whether you are eligible for HPV vaccination if you are 45 or under and unvaccinated, and discuss smoking cessation if you smoke, since both change your future risk even though neither clears the current infection.
If you are under 25 or 30 and were tested outside guidelines, ask how the result should be managed; guidelines favor repeat testing over colposcopy because clearance is so likely.

Diet, lifestyle and natural levers with evidence

What can move HPV test once the cause is known. Nothing here replaces finding the cause.

Stop smoking

Moderate evidence

Smoking is the most consistent modifiable risk factor for HPV persistence and progression. Cohort studies show current smokers are about twice as likely to have persistent infection and CIN 2/3, and a small study that followed women with low-grade lesions found the lesion shrank in about 80 percent of those who quit or cut down over 6 months. Clearance rates in former smokers approach those of never-smokers within a few years.

HPV vaccination

Strong evidence

In a Swedish registry study of 1.7 million women, vaccination before age 17 reduced invasive cervical cancer by 88 percent, and vaccination at 17 to 30 by about 53 percent. The 9-valent vaccine covers the 7 high-risk types that cause about 90 percent of cervical cancers plus the two wart types. It does not clear an infection you already have, but it protects against the types you have not yet met, and emerging data suggest vaccination at the time of LEEP roughly halves the risk of recurrent CIN 2+.

Licensed to age 45; from 27 to 45 it is a shared decision because most people have already been exposed to several types. It is not a substitute for screening.

Consistent condom use

Moderate evidence

In a prospective study of newly sexually active women, those whose partners used condoms every time had a 70 percent lower rate of new HPV infection than those using them less than 5 percent of the time. In a randomized trial of women with CIN and their partners, condom use for 2 years was associated with regression of CIN in 53 percent versus 35 percent and HPV clearance in 23 percent versus 4 percent. Protection is partial because HPV lives on skin the condom does not cover.

Lactobacillus probiotics

Preliminary evidence

A Lactobacillus-dominant vaginal microbiome is associated with roughly twice the rate of HPV clearance in cohort studies. In a small controlled pilot trial, women with low-grade cervical abnormalities who drank a Lactobacillus casei fermented milk daily for 6 months cleared the cytologic abnormality in 60 percent of cases versus 31 percent of controls, and cleared HPV in 29 percent versus 19 percent. The effect is unconfirmed in larger trials.

AHCC (a shiitake mycelium extract)

Preliminary evidence

In a single phase II randomized trial of 50 women with high-risk HPV persisting for 2 years or more, 3 g of AHCC daily for 6 months was followed by clearance in 64 percent (14 of 22) versus 10 percent (2 of 19) with placebo. The trial was small, from one center and funded in part by the manufacturer, so this is a lead rather than a recommendation.

Not a substitute for follow-up testing or colposcopy. AHCC may alter liver enzyme activity and interact with some chemotherapy drugs; tell your clinician before taking it.

When to see a clinician promptly

Bleeding after sex, between periods or after menopause, or a persistent bloody or foul discharge, regardless of your HPV or Pap result: needs an examination within days, not at your next routine screen.
A positive HPV 16 or HPV 18 result, or any positive HPV with an abnormal Pap: book the colposcopy, usually within 3 months, and attend it even if you feel well.
An HSIL or ASC-H Pap result, with or without a positive HPV test: colposcopy promptly; this is where immediate CIN 3+ risk is highest.
A positive result more than 12 months ago without any follow-up test, or a missed colposcopy: contact your clinic to reschedule, since the untreated interval is where risk accumulates.
A positive HPV test if you live with HIV, have had a transplant or take immunosuppressing medicines: follow-up is faster and more frequent in this group.
Pelvic pain, leg swelling, unexplained weight loss or difficulty urinating with a known abnormal result: urgent assessment.

Frequently asked questions

What does a positive HPV test mean?

It means a high-risk type of HPV was found in cells from your cervix. It does not mean you have cancer or precancer, and in most cases the infection clears on its own within 1 to 2 years. The result is read together with your Pap smear and the HPV type: 'other high-risk' with a normal Pap means a repeat test in a year; HPV 16 or 18, or any type with an abnormal Pap, means colposcopy to look for treatable precancer.

I am HPV positive but my Pap is normal. What happens now?

If the type is 'other high-risk' (not 16 or 18), the guideline is to repeat the HPV test or co-test in 12 months, because the immediate risk of serious precancer is about 2 percent and about half of such infections clear within a year. If the repeat is negative you go back to routine screening; if it is still positive, you have a colposcopy. If the type is HPV 16 or 18, colposcopy is recommended now even with a normal Pap.

What does HPV 16 positive mean?

HPV 16 is the single most carcinogenic type, responsible for 55 to 60 percent of cervical cancers and a large share of anal and throat cancers. A positive HPV 16 result carries an immediate risk of CIN 3 or worse of about 5 percent with a normal Pap, which is why colposcopy is recommended regardless of the Pap, and a 10-year risk of about 17 percent if it persists. Most HPV 16 infections still clear, but this one is followed closely rather than watched for a year.

HPV test vs Pap smear: which is better?

The HPV test is more sensitive: it finds about 90 to 95 percent of CIN 2 or worse on a single test, versus 50 to 80 percent for a Pap, and a negative HPV result predicts safety for 5 years rather than 3. The Pap is more specific, showing whether the virus has actually changed cells. Guidelines allow primary HPV testing every 5 years, co-testing every 5 years, or a Pap every 3 years; the first two are preferred from age 30 (25 under ACS guidance).

How long does it take HPV to go away?

About half of new high-risk HPV infections are undetectable within 6 to 12 months and about 90 percent within 2 years. HPV 16 persists longest, with a median clearance time of around 12 to 18 months. Infections still present after 2 years are less likely to clear and are the ones that need surveillance. Smoking, HIV and immunosuppression slow clearance; vaccination does not clear an existing infection.

Did my partner cheat if I tested positive for HPV?

A positive test cannot tell you when or from whom you acquired HPV. The virus can stay dormant and undetectable for years or decades and reactivate, which is why women in long-term monogamous relationships, including women over 50 with no new partner, regularly test positive. Most adults have carried HPV at some point. A new positive result is not evidence of recent infidelity by either partner.

Can men get an HPV test?

There is no FDA-approved HPV test for men, and no screening test for penile or throat HPV. Men with HIV or who have receptive anal sex may be offered anal cytology and anal HPV testing in specialized clinics. A male partner of someone who tests positive does not need testing; he almost certainly has or has had HPV, usually clears it, and vaccination up to age 45 is the only useful step.

How often should I get an HPV test?

Every 5 years from age 30 (or 25) to 65 if your result is negative, either alone or with a Pap. After a positive result the interval shortens to 1 year, and after treatment for CIN 2 or 3 to 6 months and then yearly for 3 years. Screening can stop at 65 after two consecutive negative HPV tests or co-tests in the past 10 years with no history of CIN 2+ in the past 25 years, and after a total hysterectomy for benign reasons.

References

Human papillomavirus (HPV) test. MedlinePlus, US National Library of Medicine (2024)View source
US Preventive Services Task Force. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA (2018)
Perkins RB, Guido RS, Castle PE, et al.. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Journal of Lower Genital Tract Disease (2020)
Egemen D, Cheung LC, Chen X, et al.. Risk estimates supporting the 2019 ASCCP risk-based management consensus guidelines. Journal of Lower Genital Tract Disease (2020)
Fontham ETH, Wolf AMD, Church TR, et al.. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA: A Cancer Journal for Clinicians (2020)
Khan MJ, Castle PE, Lorincz AT, et al.. The elevated 10-year risk of cervical precancer and cancer in women with human papillomavirus (HPV) type 16 or 18 and the possible utility of type-specific HPV testing in clinical practice. Journal of the National Cancer Institute (2005)
Lei J, Ploner A, Elfström KM, et al.. HPV vaccination and the risk of invasive cervical cancer. New England Journal of Medicine (2020)
Winer RL, Hughes JP, Feng Q, et al.. Condom use and the risk of genital human papillomavirus infection in young women. New England Journal of Medicine (2006)
Hogewoning CJ, Bleeker MC, van den Brule AJ, et al.. Condom use promotes regression of cervical intraepithelial neoplasia and clearance of human papillomavirus: a randomized clinical trial. International Journal of Cancer (2003)
Szarewski A, Jarvis MJ, Sasieni P, et al.. Effect of smoking cessation on cervical lesion size. The Lancet (1996)
Verhoeven V, Renard N, Makar A, et al.. Probiotics enhance the clearance of human papillomavirus-related cervical lesions: a prospective controlled pilot study. European Journal of Cancer Prevention (2013)
Smith JA, Gaikwad AA, Mathew L, et al.. AHCC supplementation to support immune function to clear persistent human papillomavirus infections. Frontiers in Oncology (2022)

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