HPV (human papillomavirus) is the most common sexually transmitted infection in the United States. Most sexually active people will have HPV at some point in their lives. The majority of HPV infections produce no symptoms, are never detected unless specifically tested for, and are cleared by the immune system within one to two years without causing any lasting changes to cervical cells.
The HPV strains that matter most for cervical health are the high-risk oncogenic strains — particularly HPV 16 and HPV 18, which together account for the majority of cervical cancers. When an HPV test identifies a high-risk strain, it means that strain is present on the cervix. It does not mean cancer is present. It does not mean cancer will develop. It means that surveillance is appropriate because persistent high-risk HPV — infection that the immune system does not clear — is the mechanism through which cervical dysplasia and, over many years, cervical cancer can develop.
HPV 16 or HPV 18 Positive (With Any Pap Result)
HPV 16 and HPV 18 are the two highest-risk strains, responsible for approximately 70 percent of cervical cancers. A positive result for either of these strains — regardless of the Pap result — proceeds directly to colposcopy. This is because the risk of high-grade dysplasia with these specific strains is high enough that waiting for an abnormal Pap before evaluating is not appropriate. The colposcopy evaluates the cervix in detail and provides biopsy specimens that determine whether dysplasia is present and its grade. Learn about colposcopy →
High-Risk HPV Positive (Not 16/18) With Normal Pap
If a high-risk HPV strain other than 16 or 18 is present but the Pap test is normal (NILM), the recommended management is repeat co-testing in one year. This surveillance allows time for the immune system to clear the infection while monitoring for any cellular changes that develop. If the repeat test at one year shows either a high-risk HPV positive result or any abnormal Pap result, colposcopy is performed. If both tests are negative at one year, return to routine screening intervals.
High-Risk HPV Positive With Abnormal Pap
When high-risk HPV is positive and the Pap shows any degree of abnormality (ASCUS, LSIL, HSIL), the combination is managed based on the most significant finding. ASCUS with positive high-risk HPV proceeds to colposcopy. LSIL with positive HPV proceeds to colposcopy. HSIL with positive HPV proceeds to colposcopy urgently. The specific colposcopy findings and biopsy results guide further management.
HPV Negative — What It Means
A negative HPV test result alongside a normal Pap test is the best possible co-testing result and allows the longest safe screening interval — five years before the next co-test. The absence of high-risk HPV provides strong reassurance against cervical cancer development in the near term, because cervical cancer does not develop without persistent high-risk HPV infection.
Persistent HPV Positive — Two or More Consecutive Positive Results
Persistence of high-risk HPV across two or more testing intervals is a more significant finding than a single positive result, because persistent infection — rather than transient infection — is the driver of progressive cervical dysplasia. Women with persistent high-risk HPV alongside normal Pap results at one year proceed to colposcopy rather than continued surveillance alone. The clinical management of persistent HPV acknowledges that immune clearance has not occurred and direct cervical evaluation is the appropriate next step.
Contact our office to schedule follow-up within the recommended timeframe:
- HPV 16 or HPV 18 positive: Colposcopy within 4 to 6 weeks regardless of Pap result
- High-risk HPV positive with HSIL Pap: Colposcopy within 4 to 6 weeks
- High-risk HPV positive with ASCUS or LSIL: Colposcopy within 3 to 6 months
Result-Specific Counseling
The specific follow-up pathway for your HPV result depends on which strain was identified, what the accompanying Pap result showed, your prior testing history, and your age. Dr. Andrei reviews all of these factors and provides the specific recommendation for your result combination — with a clear explanation of why that recommendation is appropriate for your situation.
In-Office Colposcopy When Indicated
When colposcopy is indicated by your HPV result and Pap combination, it is performed in-office at both our Lapeer and Rochester Hills locations. The procedure takes approximately 15 minutes and provides the biopsy specimens that characterize any dysplasia precisely.
Surveillance and Treatment Continuity
Whether your management pathway involves surveillance with repeat testing or colposcopy with possible treatment, Lapeer Women’s Health provides continuity of care through every step — from the initial HPV-positive result through the completion of treatment and the post-treatment surveillance period.
Most women who receive a positive HPV test will have their infection clear without ever developing cervical dysplasia. Of those who develop dysplasia, most will have low-grade findings that resolve without treatment. Of those who develop high-grade dysplasia, treatment with LEEP or conization is highly effective at preventing progression to invasive cancer. The entire pathway from HPV positive to cervical cancer takes years to decades — and the screening and treatment system is designed to interrupt it at the dysplasia stage, long before cancer develops.
Dr. Ramona D. Andrei and the team at Lapeer Women’s Health are here to navigate that pathway with you — at both our Lapeer and Rochester Hills offices, without a referral required.
Our team at Lapeer Women’s Health provides result-specific follow-up for HPV-positive results at both offices. No referral required.
Schedule a Gynecologic VisitEducational purposes only. Not medical advice. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.
Gynecologic care for women of every age
Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307
Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.