Follow-Up of Self-Collected Human Papillomavirus (HPV) Testing
Find follow-up guidance for health care providers with patients who opt to pay for self-collected HPV testing.
HPV-Negative Results
People with self-collected HPV-negative results can be re-screened with a cervical screening test in 3 years.
HPV-Positive, HPV-Invalid or HPV-Indeterminate Results
Step 1: Provider-collected cervical sample
People with self-collected HPV-positive, HPV-invalid or HPV-indeterminate results should visit a primary care provider for a provider-collected HPV test (with reflex cytology) at their earliest convenience, within 3 months. Unlike with a provider-collected cervical sample, cytology to check for abnormal cervical cells cannot be completed on self-collected vaginal samples so additional testing is required to determine a participant’s risk of developing cervical pre-cancer and cancer and inform next steps in their care.
Clinical next steps for people with self-collected HPV test results are outlined in the following table.
| SELF-COLLECTED HPV RESULT | NEXT STEP |
|---|---|
| HPV-negative; | Re-screen in 3 years |
| HPV-positive (16, 18 or other high-risk types*) | Repeat screening with a provider-collected HPV test (with reflex cytology) at the patient’s earliest convenience, within 3 months |
| HPV-invalid or indeterminate; | Repeat screening with a provider-collected HPV test (with reflex cytology) at the patient’s earliest convenience, within 3 months |
*Includes all non-16/18 HPV results (e.g., 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68)
Step 2: Exit self-collected pathway and enter provider-collected pathway
Results of the provider-collected HPV test (with reflex cytology) will inform next steps in the patient’s care. For more information about provider-collected cervical screening recommendations, visit ontariohealth.ca/OCSP-recommendations
Indications for HPV Testing
HPV testing should only be used for cervical screening.
HPV testing should not be used as a sexually transmitted infection test (e.g., to determine if someone has contracted an HPV infection from a new sexual partner) for 2 reasons:
- HPV tests only detect certain subtypes of HPV.
- Of the over 100 subtypes of HPV, the HPV test only tests for 13 subtypes that are considered oncogenic (i.e., subtypes that cause cervical cancer).
- The HPV test does not test for non-oncogenic subtypes of HPV, such as those that cause genital warts.
- As such, a negative HPV test does not necessarily mean someone does not have an HPV infection. It only means that an oncogenic HPV infection was not detected.
- Screening too frequently does not provide extra protection and can cause harm.
- Most oncogenic HPV infections clear on their own, but it can take several years. Almost 80% of infections clear within 3 years.[1]
- Only persistent oncogenic HPV infections cause cervical cancer, but it takes many years to develop (15 to 20 years in people who are immunocompetent).[2]
- There is no treatment for oncogenic HPV infections. Only the pre-cancer and cancer that can develop as a result of a persistent oncogenic HPV infection can be treated.
- Therefore, screening too frequently is not beneficial. In fact, screening too frequently increases the risk of detecting transient HPV infections which can lead to unnecessary colposcopy. Colposcopy is a potentially invasive exam with associated risks, such as anxiety, discomfort and pain.
[1] Demarco M, Hyun N, Carter-Pokras O, Raine-Bennett TR, Cheung L, Chen X, et al. A study of type-specific HPV natural history and implications for contemporary cervical cancer screening programs. EClinicalMedicine. 2020 May;22:100293.
[2] World Health Organization. Cervical Cancer [Internet]. 2019 [cited 2022 Sep 22]. Available from: Cervical cancer (who.int)