Should family physicians test for human papillomavirus infection? An opposing view

Recent advances in the field of molecular biology have expanded the knowledge of HPV manifestations. We have attempted to separate those circumstances when HPV testing may be useful in patient management and when it may not. Routine screening for HPV has not yet been shown to be useful. One must weigh informing 10% of patients that they have a potentially oncogenic virus against the ability of a repeat Papanicolaou smear to detect the lesion. On the other hand, HPV detection in the setting of an abnormal Papanicolaou smear and an acetowhite lesion that on biopsy lacks the histologic features of CIL does predict who is at high risk for CIL. HPV typing should not affect clinical management, and we do not recommend it. HPV detection by in situ hybridization is a very useful adjunct to histological analysis in genital tract lesions that are clinically suggestive of an HPV lesion but where the histological analysis is equivocal. This ability to distinguish true HPV lesions from its mimics is often crucial to the patient, given the implications of having a sexually transmitted disease.