High-risk HPV DNA testing and HPV-16/18 genotyping: what is the clinical application?

There are currently 2 tests approved for clinical use that nonspecifically detect the presence of multiple oncogenic or high-risk human papillomavirus (HPV) types. One HPV genotyping test is also available for use that specifically detects the presence of high-risk HPV types 16 and 18. The purpose of this review was to evaluate the clinical performance of these HPV DNA tests and the utility of the tests within current screening recommendations.

The sensitivity and specificity of currently available HPV DNA tests to detect the presence of precancerous high-grade cervical lesions are reviewed. Appropriate test usage is discussed in the context of the natural history of HPV infection.

Molecular testing for the presence of high-risk HPV is more sensitive but less specific than cytologic testing for the detection of high-grade cervical lesions. Current patient management guidelines recommend the use of high-risk HPV DNA testing to triage women 21 years or older with equivocal cytology results and in conjunction with cytology for cervical screening in women 30 years or older. The HPV-16/18 genotyping test may be used in women 30 years or older with negative cytology and positive high-risk HPV DNA test results to determine the need for colposcopy.

Although infection with high-risk HPV is highly prevalent in adult females, most infections are transient and do not require intervention. Clinical application of appropriate age-adjusted use of HPV DNA testing and its use in conjunction with atypical squamous cells of undetermined significance cytology will avoid unnecessary follow-up procedures.