Receiving a positive HPV test result can be unsettling. And yet, in the vast majority of cases, this result means neither cancer nor immediate danger. What matters is understanding precisely what it implies — and knowing exactly what steps to take depending on your situation. That is what this article is about.
For a full overview of cervical surgery, see our dedicated page: cervical surgery.
How is HPV transmitted?
HPV is transmitted through skin and mucosal contact during sexual activity — with or without penetration. The virus follows sex wherever it goes: it can infect the cervix, vagina, vulva, anus and perineum, as well as the penis in men, and the mucous membranes of the throat, mouth and pharynx (oro-pharyngeal HPV). Some oropharyngeal cancers, currently on the rise, are directly linked to HPV infections transmitted during oral sex.
Condoms reduce — but do not completely eliminate — the risk of transmission, as the virus can be present on areas not covered by a condom (vulva, perineum, base of the penis). It is a partial protection, useful but not sufficient on its own to prevent all transmission.
Important: there is no antiviral treatment that can eliminate HPV once it has established itself. HPV infection is not "cured" in the traditional sense — what we do is monitor its progression and treat any potential consequences: certain lesions are persistent and will not progress, others are transforming and may evolve towards cancer if left unmanaged. In 90% of cases, the immune system eliminates the virus naturally. In terms of screening, the cervical smear is the reference test for the general population. An anal smear also exists and is performed in immunocompromised patients (HIV, transplant recipients) for whom the risk of HPV-related anal cancer is significantly higher — but it is not part of standard screening.
What does a positive HPV test mean?
A positive HPV test means you are carrying one or more types of human papillomavirus (HPV). HPV infection is extremely common: approximately 80% of sexually active women and men contract at least one HPV infection during their lifetime. This result is therefore not rare, and does not in itself constitute a diagnosis of cancer.
HPV types are divided into two broad categories: low-risk types (HPV 6 and 11, mainly responsible for genital warts) and high-risk oncogenic types — notably HPV 16, 18, 31, 33, 45, 52, 58 — which can potentially progress to cervical cancer if the infection persists over several years. Important: the HPV test carried out as part of cervical screening only looks for high-risk oncogenic types — low-risk types (HPV 6, 11) are not detected by this test.
Key point: in 90% of cases, the immune system eliminates the HPV infection naturally within 12 to 24 months, without any medical intervention. Only persistent infections require closer monitoring.
Interpreting your result
The HPV type detected matters
Modern HPV tests distinguish between types 16 and 18 and other high-risk strains. This distinction guides the monitoring schedule: an HPV 16 or 18 positive result leads to a colposcopy sooner, while other high-risk types are monitored according to the associated smear result. In all cases, it is worth remembering that the vast majority of these infections will disappear without any consequence.
The associated smear result
The screening algorithm depends on age. Between 25 and 30, a cytology (cervical smear) is performed first. Only if cytological abnormalities are found does the laboratory automatically run a "reflex" HPV test on the same sample already taken — without requiring a new procedure. From age 30 onwards, the logic is reversed: the HPV test becomes the first-line examination, and cytology is only analysed as a complement if the HPV test is positive.
The screening programme by age
Before age 25: no screening
Before the age of 25, there is no cervical cancer screening — and this is intentional. At this age, a young woman has often been exposed to HPV since her very first sexual encounters, and close to 90% will clear the virus spontaneously, without any intervention. Screening at this age would lead to unnecessary examinations and treatments, more harmful than beneficial. Screening begins at age 25.
Ages 25 to 29: cytology first, reflex HPV if abnormal
Between ages 25 and 29, screening is based on cytology alone — that is, analysis of the cells collected during the cervical smear. The schedule is precise: a first smear at 25, a second at 26, then a check-up at 29.
If cytology is normal, no additional examination is needed until the next scheduled appointment. If it reveals an abnormality, the doctor can ask the laboratory to run a "reflex" HPV test on the same sample already taken — no new procedure required. This reflex HPV result then guides the next decision: simple surveillance or colposcopy.
From age 30: HPV as the primary test
From age 30 onwards, the logic reverses. The procedure is identical — a cervical smear — but it is now the HPV test that is requested first by the laboratory. If this test is negative, smears only need to be repeated every 5 years. If the HPV test is positive, the laboratory then analyses the cytology from the same sample and, based on the combined results, colposcopy will be recommended or not.
Colposcopy: what it is and why it matters
A smear — whether cytological or combined with an HPV test — is a screening examination: it detects a warning signal, but does not allow direct visualisation of the cervix or characterisation of a lesion. That is where colposcopy comes in.
Colposcopy is an examination performed at the gynaecologist's office, without anaesthesia, in around fifteen minutes. The doctor uses a colposcope — a type of binocular microscope positioned at a distance — to examine the cervix, vagina and vulva after applying acetic acid, which highlights abnormal cell areas in white, and sometimes Lugol's iodine. Where the smear provides indirect cellular information, colposcopy allows the doctor to directly visualise suspicious areas and take targeted biopsies if necessary.
These biopsies, analysed by a pathologist, determine the grade of any lesions (CIN 1, CIN 2, CIN 3) and — crucially — distinguish persistent lesions, which will not progress, from transforming lesions, which may evolve towards cancer if left untreated.
What is CIN? Cervical intraepithelial neoplasia (CIN) refers to cervical lesions classified in 3 grades. CIN 1 most often corresponds to a persistent lesion that will regress spontaneously in around 60% of cases. CIN 2 and CIN 3 are potentially transforming lesions — they may progress to invasive cancer if not monitored or treated.
Follow-up and surveillance
High-risk HPV positive with negative cytology
If the high-risk HPV test is positive but cytology is normal, a check-up at 1 year is performed. If this follow-up comes back negative, standard screening resumes. If the HPV test is still positive at 1 year, colposcopy is then indicated — persistence of the virus warrants direct examination of the cervix.
CIN 1
CIN 1 is not treated. It is monitored. These lesions regress spontaneously in approximately 60% of cases within two years, and immediate intervention would in the vast majority of cases be unjustified. Regular check-ups allow confirmation of regression and detection of any potential progression.
CIN 2 or CIN 3
High-grade lesions generally require treatment. Available techniques include: conisation (removal of a cone of cervical tissue), electrosurgical excision, cryotherapy or laser vaporisation. The choice depends on the extent of the lesions, your age and your plans for pregnancy.
After treatment, a follow-up HPV test is performed at 6 months. If negative, the risk of recurrence is very low. Annual check-ups are then maintained for at least 2 years.
CIN 2 or CIN 3: don't wait
These lesions require surgical management. Dr Zeitoun sees patients promptly at his Paris 8th arrondissement practice or at Clinique Hartmann, Neuilly-sur-Seine, to review your case and plan the appropriate procedure.
Book an appointment →Hysterectomy does not eliminate HPV
This is a question many patients ask, and it is entirely understandable: "Could we simply remove the cervix, or even the whole uterus, to be done with this virus?" The answer is no — and it is important to understand why.
HPV is not confined to the cervix. It is present in the surrounding mucous membranes — the vagina, vulva and perineum. Removing the cervix or uterus does not eliminate the virus. After a total hysterectomy, screening continues in the form of vault smears at the top of the vagina, which can detect any residual lesions on the remaining vaginal mucosa. A hysterectomy is therefore never a solution for "getting rid of" HPV — it is a procedure with its own medical indications, entirely independent of HPV status.
Prevention and everyday advice
Stopping smoking
Smoking is a major cofactor in the progression of HPV infections. Cigarette smoke contains carcinogens that accumulate in cervical secretions and weaken local immunity. Stopping smoking, even after a positive result, significantly improves the outlook.
Diet and lifestyle
There is currently no robust scientific evidence that any particular diet, supplement or lifestyle change can speed up HPV clearance. General advice about antioxidants or balanced diets found online is not supported by sufficiently strong data to be recommended. What is clearly established is the negative impact of smoking — detailed above — and the protective role of vaccination.
HPV vaccination: a decisive tool
The nonavalent Gardasil 9 vaccine protects against 9 HPV types responsible for 90% of cervical cancers. If you are only infected with certain types, vaccination can protect against the other strains not yet contracted. Being vaccinated does not exempt you from screening: other strains not covered by the vaccine can still be contracted, and the smear programme remains essential, vaccinated or not.
Australia's experience is striking: a pioneer in HPV vaccination from 2007, with a national programme covering adolescents of both sexes, the country is now on the verge of virtually eliminating all HPV-related cervical cancers. Australian studies show a dramatic fall in HPV 16 and 18 infections, in high-grade lesions, and in cancer cases among vaccinated age groups. This is the strongest evidence we have of the effectiveness of primary prevention — and a compelling reason to vaccinate children and adolescents before any exposure to the virus.
Sexual health and partners
A positive HPV test says nothing about fidelity — yours or your partner's. This is a fundamental point. The virus can lie dormant for years — sometimes since the very first sexual encounter — and reactivate spontaneously years later, without any new contact. It may also have been transmitted by your current partner, who is unaware of it, or be passed back and forth within the couple: this is simply the natural history of the virus, not a sign of infidelity.
In men, there is no way to screen for HPV: no validated test, no equivalent smear. A male partner can therefore carry the virus without knowing it and without being able to find out other than through his partner's diagnosis. Condoms partially reduce the risk of transmission but do not cover all potentially infected areas (vulva, perineum, scrotum). Their use remains useful without being an absolute guarantee.
Frequently asked questions
Conisation, polyp removal, treatment of ectropions and CIN lesions: Dr Zeitoun presents the full range of benign cervical surgical procedures, their indications and their impact on fertility.
