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Follow-Up of Self-Collected Human Papillomavirus (HPV) Testing

Self-collected human papillomavirus (HPV) testing is available in Ontario, however it is not currently insured by the Ontario Health Insurance Program (OHIP) or recommended by the Ontario Cervical Screening Program.

Find follow-up guidance for healthcare providers with patients who opt to pay for a self-collected HPV test.

Disclaimer: The next steps provided on this webpage are based on data from physician collected samples.

HPV-Negative Results

People with HPV-negative results can be rescreened with a cervical screening test in 5 years.

Cytology testing for people with HPV-negative results is not necessary because evidence shows that HPV/cytology co-testing results in a higher proportion of false positive results (i.e., people with falsely positive screening results who have insignificant abnormalities) and a higher number of inappropriate referrals to colposcopy, which has risk for patients.

HPV-Positive Results

Step 1: Cytology testing

People with HPV-positive results need to visit a primary care provider for cytology testing.

People referred to colposcopy with HPV test results only may be declined because an HPV-positive result alone is not an appropriate indication for colposcopy.

Cytology testing is essential to determine a person’s risk of pre-cancer and cervical cancer and enables risk-based management (colposcopy vs. repeating the HPV test in 2 years).

A self-collected sample mostly contains cells from the vagina and not the cervix. While the HPV test does not need cells from the cervix, a cytology test is the direct examination of cervical cells and is not reliable when performed on a self-collected sample.

Step 2: Management based on HPV and cytology results

Clinical next steps for people with HPV and cytology testing results are outline in the following table.

HPV and cytology testing results
HPV Result Cytology Result – High Grade* Cytology Result – Normal or Low Grade**
HPV 16 Refer to colposcopy Refer to colposcopy
HPV 18 Refer to colposcopy Refer to colposcopy
HPV (other high-risk subtype)*** Refer to colposcopy Repeat HPV test in 2 years

*High-grade cytology results include High-grade squamous intraepithelial lesion (HSIL), atypical squamous cells, cannot exclude HSIL (ASC-H), Low-grade squamous intraepithelial lesion, cannot exclude HSIL (LSIL-H); Atypical glandular cells (AGC); Atypical endocervical cells (ACE); Adenocarcinoma in situ (AIS); Adenocarcinoma (ACC); Endocervical adenocarcinoma (ACC-E); or Squamous cell carcinoma (SCC)

**Low-grade cytology results include: Atypical squamous cells of undetermined significance (ASCUS); Low-grade squamous intraepithelial lesion (LSIL)

***Includes all non-16/18 HPV results (e.g., 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68)

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)