Positive HPV but a Normal Pap Test: What Happens Next?

A positive HPV test with a normal Pap means a high-risk type of human papillomavirus was found in your cervical sample, but no abnormal cell changes were seen. It is not a cancer diagnosis. In most cases the next step is a repeat test, often in about a year, to check whether the virus has cleared.

This guide is for adults who already have this combined result and want to understand the usual follow-up. It cannot tell you your personal risk or replace the plan from your screening service or clinician. If your result says the sample was inadequate or unsatisfactory, that is a different situation, covered in a separate guide.

A screening result is not a reason to ignore new symptoms. The NHS advises seeing a GP if you notice any of the following, whatever your last screening result was. These symptoms have many possible causes, and most are not cancer, but they should be checked rather than left until the next screening invitation.

• Vaginal bleeding that is unusual for you, such as during or after sex, between periods or after menopause.
• Periods that are heavier than usual.
• Changes to vaginal discharge.
• Pain during sex.
• Pain in the lower back, pelvis or lower tummy.

The US National Cancer Institute (NCI) says most HPV infections go away on their own without causing cancer, and that the immune system usually clears them within a year or two.

The concern is an infection that lasts. According to the NCI, a long-lasting high-risk infection can, over years, cause precancerous changes in cervical cells. It can take 5 to 10 years for infected cells to become precancers and about 20 years to develop into cancer. Repeat testing aims to find the infections that do not clear, long before that stage.

The NCI lists factors that make a lasting infection more likely. These include a weakened immune system, HIV infection, medicines that suppress the immune system and smoking. Tell the clinician if any of these apply to you.

There are many types of HPV. The NCI lists a group of high-risk types linked to cancer, including 16, 18, 31, 33, 45, 52 and 58. It says HPV 16 and HPV 18 cause most HPV-related cancers.

Some laboratories report only whether high-risk HPV was found. Others also say whether type 16 or 18 was present. The CDC notes that the specific HPV type may be identified to help decide the next steps. A result showing type 16 or 18 can lead to a different plan, such as earlier colposcopy, even when the cells look normal. Ask whether your report includes the type and how it changes your follow-up.

For many people with positive HPV and normal cells, the first step is a repeat test rather than an immediate procedure. This gives the immune system time to clear the virus. Colposcopy becomes more likely if HPV is still there on repeat testing, if the cells change, or if other risk factors apply.

A colposcopy is a closer look at the cervix using a magnifying instrument. The NHS says it can feel uncomfortable and some people find it painful, and you can ask to stop at any time. A small tissue sample (biopsy) may be taken. The NHS says biopsy results can take 4 to 8 weeks.

Being offered a repeat test instead of a colposcopy does not mean your result was ignored. Being offered a colposcopy does not mean cancer was found. Both are ways of monitoring a virus that usually clears.

Screening programmes are organised differently, so the same result can lead to slightly different plans depending on where you live.

In the NHS programme, the sample is checked for high-risk HPV first, and the cells are checked only if HPV is found. The NHS says that if HPV is found but the cells are normal, you will be invited for screening again in 1 year, and again 1 year later if you still have HPV. If HPV is still present after 2 years, you will be asked to have a colposcopy.

In the US, screening may use a Pap test alone, an HPV test alone, or both together (co-testing), depending on age. The NCI explains that under updated ASCCP guidelines, follow-up is based on your current result, your previous screening results, any past treatment and personal factors such as age. Depending on your risk, you may be advised to repeat testing in 1 or 3 years, have a colposcopy or, less often, have treatment.

Other countries have their own programmes. If you have moved between countries, bring previous results so the clinician can see your history.

These questions can help you leave the conversation with a clear plan. Write the answers down and keep the original report.

• Was my HPV result for high-risk HPV in general, or does it say whether type 16 or 18 was found?
• Do my previous screening results change the plan?
• Am I being advised to repeat the test, or to have a colposcopy now? Why?
• When exactly is my next test, and will I be sent an invitation or do I need to book it?
• What would happen if HPV is still present next time?
• Is there anything about my health, such as my immune system or smoking, that changes my follow-up?
• Which symptoms should make me contact you before the next test?

On SameCase, patients and verified doctors share de-identified cases. Reading how others with positive HPV and a normal Pap described their results, what follow-up they were offered and which questions they asked can help you prepare for your own appointment. Another person's case cannot tell you what your result means for you or replace the plan from your screening service.

The most important step after this result is not missing the repeat test. Note the date, check how the invitation will reach you and update your contact details with your clinic or screening service if they have changed. If you have not heard anything by the expected time, contact them and ask.

Keep each report together so the trend is easy to see. A result that changes from HPV positive to HPV negative is reassuring news, and a result that stays positive simply moves you to the next planned step.