Screening & Gynecologic Cancer
HPV Test vs. Pap Smear: What's the Difference and Which Do You Need?
A Pap smear looks at cervical cells under a microscope for abnormal changes. An HPV test checks the same kind of sample for high-risk human papillomavirus, the virus behind nearly all cervical cancers. From 21 to 29, a Pap test every 3 years is standard. From 30 to 65, an HPV test every 5 years is a preferred option.
From your side of the speculum, the two tests feel identical. Often they come from the exact same swab. The difference is what the lab does with it.
Side by side
| Pap test (cytology) | HPV test | |
|---|---|---|
| What it finds | Abnormal cervical cells | High-risk HPV infection |
| How the sample is taken | Brush or spatula during speculum exam | Same sample, or a self-collected swab in some offices |
| Ages used alone | 21–65 | 30–65 (25–65 under ACS guidance) |
| Interval if normal | Every 3 years | Every 5 years |
| Main strength | Shows actual cell changes | Very good at identifying who is low risk |
| Main weakness | Can miss some abnormal cells | Positive results are common and often clear on their own |
What the Pap test is looking for
A Pap test (cervical cytology) collects cells from the surface of your cervix, and a lab looks at them under a microscope. The report says whether they look normal or show changes, from mild (ASC-US, LSIL) to more serious (HSIL).
Pap tests have been around since the mid-1900s and are a big reason cervical cancer deaths in the U.S. fell so sharply. Their weakness: a single Pap can miss some abnormal cells, which is why it's repeated every 3 years when used alone.
What the HPV test is looking for
The HPV test looks for the DNA or RNA of high-risk HPV types. There are more than a dozen. HPV 16 and 18 cause most cervical cancers, and many tests report whether 16 or 18 is present, plus a result for "other high-risk types."
Here's the part people are often embarrassed to ask about: HPV is extremely common. Most sexually active people get it at some point, and most infections clear on their own within one to two years. A positive test doesn't say anything about your partner's faithfulness or yours; the virus can stay quiet for years before showing up. The concern is an infection that persists, because that's what can lead to precancer.
What it's not:
- It doesn't test for the low-risk types that cause genital warts.
- It isn't an STI panel. It doesn't check for chlamydia, gonorrhea or anything else. If you want those, ask separately.
Co-testing vs. primary HPV testing
Co-testing means running a Pap and an HPV test on the same sample. If both are negative, you can wait 5 years. It's an accepted option for ages 30 to 65.
Primary HPV testing means running the HPV test first, and only looking at the cells if HPV is found. The American Cancer Society prefers it, and the USPSTF and ACOG list it as an option. Which one you get often comes down to your clinician's lab, not a judgment about you.
Why not HPV testing in your 20s?
HPV is very common in people in their 20s, and most infections go away without causing harm. Testing for HPV alone at this age would flag many people who don't need anything done. For 21 to 29, a Pap every 3 years works better.
HPV testing can still show up in your 20s as a follow-up after an ASC-US Pap result. That's called "reflex" HPV testing, and it helps sort out whether a mild change needs a closer look.
Does it hurt?
No more than a Pap, because it's the same exam. Most people feel brief pressure from the speculum and a light scraping from the brush, about 10 to 20 seconds of actual sampling. Slight spotting afterward is normal. If speculum exams are hard for you, say so; a smaller speculum and going slowly help a lot.
When results don't match
Positive HPV, normal Pap
One of the most common results. It usually means you have HPV but no visible cell changes. Often the next step is a repeat test in one year. If HPV 16 or 18 is found, a colposcopy is usually recommended. Full guide: positive HPV test with a normal Pap.
Negative HPV, abnormal Pap
If the Pap shows ASC-US but HPV is negative, the risk of serious disease is low, and many people go back to routine screening in 3 years. More serious Pap results, such as HSIL, still need follow-up even if HPV is negative.
Both positive
You'll usually be referred for a colposcopy, a magnified look at the cervix.
Follow-up decisions come from the ASCCP risk-based guidelines, which weigh your current result, past results and any treatment history. Two people with the "same" result can get different advice for good reason.
Can I collect the sample myself?
Increasingly, yes. In 2024 the FDA approved self-collection of vaginal samples for HPV testing in a health care setting: you use a swab in a private room, and it goes to the lab. Studies show self-collected HPV samples are about as accurate as clinician-collected ones for finding precancer. In May 2025 the FDA approved the first kit for collecting the sample at home, prescribed through telehealth for average-risk people 25 to 65.
Self-collection checks only for HPV. If it's positive, you'll need a clinician-collected sample or a colposcopy next. It also isn't meant for everyone; people who are immunocompromised or have been treated for precancer usually need clinician-collected testing. Ask your provider whether they offer it.
I got the HPV vaccine. Do I still need testing?
Yes. The vaccine protects against the HPV types that cause most, but not all, cervical cancers, and many adults were vaccinated after they'd already been exposed. Vaccinated people follow the same screening schedule. See the HPV vaccine for adults.
When to see a doctor
Screening is for people who feel fine. Don't wait for your next test if you have:
- Bleeding after sex or between periods
- Any bleeding after menopause
- Unusual discharge that's watery, bloody or has a bad smell
- Ongoing pelvic pain
Also call if you got an abnormal result and aren't sure what happens next. Missed follow-up is a common reason precancer doesn't get treated in time. Ask for your actual result in writing so you know what you had and when.
Need a provider? Search the directory for gynecologists and nurse practitioners across New York City, Long Island and the Hudson Valley, or browse providers in Queens and other boroughs. Many take Medicaid.
Frequently asked questions
What is the difference between an HPV test and a Pap smear?
An HPV test checks for high-risk types of human papillomavirus, the virus that causes nearly all cervical cancers. A Pap smear looks at cervical cells under a microscope for abnormal changes.
Is an HPV test better than a Pap smear?
For people 30 and older, HPV testing is more sensitive than a Pap test at finding those at risk of precancer, which is why many guidelines prefer it every 5 years. A Pap test is still the standard test for people 21 to 29.
Is the HPV test done the same way as a Pap smear?
Yes. Both use cells collected from the cervix during a speculum exam, often from the same sample. Some offices now also offer a self-collected vaginal swab for HPV testing.
Can men get an HPV test?
There is no FDA-approved routine HPV screening test for men. HPV screening is designed for the cervix.
Sources
- USPSTF — Cervical Cancer: Screening
- ACOG — Cervical Cancer Screening (Frequently Asked Questions)
- American Cancer Society — Guideline for Cervical Cancer Screening
- National Cancer Institute — HPV and Pap Testing
- CDC — Basic Information About HPV
- FDA — Approval of first at-home self-collection device for cervical cancer screening (May 2025)
This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.