A Guide to HPV Co-Testing

how to treat HPV

One of the most common ways to check for HPV is co-testing. This routine screening is recommended for many adult women. Learn more about how co-testing works and when you should receive this important HPV test.

What is Co-Testing?

Co-testing involves two routine screenings which are performed at the same time:

  1. A Pap test (sometimes called a Pap smear), which is a screening for abnormal cervical cells.
  2. An HPV test, which checks for DNA from HPV in cervical cells.

Doctors are able to use the same cell sample for both tests, which saves time and helps to ensure that women get the proper health screenings to prevent cervical cancer.

Pap & HPV Co-Testing Guidelines

The recommendations for getting Pap and HPV tests vary by age:

  • Women ages 21 through 29 should get a Pap test every three years.
  • Women ages 30 through 65 should get a Pap and HPV co-test every five years.
  • Women over 65 only need a Pap test if they’ve never gotten these tests or haven’t been tested since age 60.

Women over 65 who have received routine co-tests with normal results over the previous 10 years likely do not need Pap or HPV testing anymore. In addition, women who no longer have a cervix after a hysterectomy and who don’t have a history of cervical cancer don’t need to receive these tests either.

What to Expect During Co-Testing

At your co-testing appointment, you’ll lie on your back on the exam table and place your feet into stirrups on either side of the table. During the test, your doctor will insert a speculum into your vagina and open it to see your cervix. Then, they’ll use a swab to collect cells from the cervix which are then sent on to a laboratory for testing.

Co-testing only takes a few minutes. There is usually a bit of pressure as the speculum is inserted and opened. You might experience some discomfort, but it should not be painful. If you’re concerned about feeling pain during the procedure, you can take an over-the-counter pain reliever about an hour before your co-test. Some women experience light bleeding from the vagina after the exam.

Co-Test Results

Most HPV test and Pap smear results come back in about one to three weeks. You’ll get one of the following results for the Pap smear:

  • Normal: Your Pap smear did not show any abnormal cells and no further testing is needed until your next routine screening.
  • Unclear: The doctor is unsure whether your cells appear normal or abnormal. The doctor will perform another Pap test right away or in six months to a year to rule out any concerns.
  • Abnormal: The cells from your test appear to be abnormal and you need further testing. If the changes look serious, your doctor may recommend a biopsy or colposcopy. If the changes are minor, your doctor may want to perform another Pap test before recommending other treatment options.

In most cases, people receive a normal result on their Pap test. Results labeled as unclear or abnormal are not a cancer diagnosis. A number of other factors can cause an abnormal Pap smear besides cancer, including yeast infections, cysts, hormonal changes, or immune system issues, which is why follow-up testing is recommended.

For the HPV test, you’ll receive a positive or negative result. If you’re HPV-positive, the test will show what type of HPV you have. Certain high-risk HPV types are known to cause cancer, so your doctor can determine how to proceed based on which type you have.

Co-testing is not a form of HPV prevention. However, it’s an important screening that can help to determine your risk for cervical cancer. Use these guidelines to make sure you receive adequate testing.

  1. Pap and HPV tests: U.S. Department of Health & Human Services Office on Women’s Health, 2019.
  2. Cervical Cancer: Screening: U.S. Preventive Services Task Force, 2018.
  3. HPV and Pap Testing: National Cancer Institute, 2019.