Primary HPV Screening: What’s Changing About Your Cervical Cancer Screening

For decades, cervical cancer screening meant one thing: a Pap smear during a speculum exam. That is no longer the only way to do it. Testing directly for the virus that causes nearly all cervical cancers has proven more accurate than the Pap test alone, and for many patients it now does not require a speculum at all. At MAIA Gynecology in Downers Grove, we follow the screening guidelines of the American College of Obstetricians and Gynecologists (ACOG), and patients between 30 and 65 can now choose between three ways to be screened, including primary HPV screening without a speculum. Here is what changed, and how to decide which option fits you.

Why Testing for the Virus Comes First

Nearly all cervical cancers are caused by a long-lasting infection with a high-risk type of human papillomavirus (HPV). Most HPV infections clear on their own, but a few high-risk types, especially HPV 16 and HPV 18, can cause cell changes that develop slowly into cervical dysplasia and, over many years, potentially cancer.

A Pap smear looks for those cell changes once they have happened. Primary HPV screening looks for the virus itself, which means it can flag risk before changes are visible. It catches more problems early, and a negative result gives reassurance for longer, so screening can happen less often. Co-testing pairs the two, checking for HPV and examining cells from the same sample.

Your Screening Options at Each Age

Age	Recommended approach	How often, if normal
21 to 29	Pap test	Every 3 years
30 to 65	HPV test you collect yourself in our office, no speculum	Every 3 years
30 to 65	HPV swab collected by your provider, no speculum	Every 3 years
30 to 65	HPV test with a Pap “backup,” collected during a speculum exam	Every 5 years
Over 65	Many patients can stop	Only if screening has been kept up and recent results were all normal

A history of cervical dysplasia or abnormal results can change this schedule, and so can certain health conditions. Your provider will review your history before recommending an interval.

Self-Collected, Provider-Collected, or With a Pap Backup

All three options for patients 30 to 65 are available at MAIA. They differ mainly in how the sample is collected and how often you come back.

Collecting the sample yourself

You use a swab to collect your own sample here in our office, with no speculum exam. It is a good fit for patients who find speculum exams painful or stressful, and for anyone who would simply prefer it.

Having your provider take the swab

Your provider collects the sample with a swab, also without a speculum. Some patients like knowing a clinician handled the collection while still skipping the speculum.

HPV testing with a Pap backup

This is collected during a speculum exam, often alongside your pelvic exam. Because both the virus and the cells are checked, a normal result lets you wait five years before the next screen. If you are due for a pelvic exam anyway, this can be the efficient choice.

There is no single right answer. Your provider can help you weigh comfort, convenience, and your own history. You can read more about how we approach HPV screening at MAIA and how it compares with a traditional Pap smear.

If Your Result Comes Back Positive

A positive result means a high-risk HPV type was found. It does not mean you have cancer, and it does not mean cancer will develop. It means your provider wants a closer look or a closer schedule. Depending on the HPV type and your history, next steps may include:

• A Pap test to check the cells, either on the same sample or at a follow-up visit, depending on how your sample was collected

• Repeating the HPV test in about a year to see whether the infection has cleared

• A closer view of the cervix with colposcopy using our Lutech video colposcope, done here in the office

• Treatment such as a LEEP procedure if a biopsy shows changes that should be removed

Our article on next steps after an abnormal Pap smear walks through what follow-up can look like.

Where Screening Fits in Your Annual Visit

Cervical screening is one part of your annual wellness visit, which can also include a breast exam, STD screening, and time to talk about contraception, perimenopause, or anything else on your mind. Even in a year when you are not due for an HPV test, the annual visit is still worth keeping.

Our board-certified gynecologists, Dr. Karen Wolowick, DO, Dr. Susan Mitchell, and Dr. Colleen Skay, along with Ashley Cox, PA-C, a board-certified physician assistant, can walk you through the options at your visit.

What Patients Want to Know About the New Approach

Is primary HPV screening the same as a Pap smear?

No. A Pap smear looks at cervical cells for abnormal changes. Primary HPV screening tests for the high-risk virus that causes those changes. Co-testing, the HPV test with a Pap backup, checks for both.

Do I still need a pelvic exam if I collect my own sample?

Self-collection replaces the speculum portion of cervical screening, not your whole annual visit. Whether you need a pelvic exam that year depends on your symptoms and history, and your provider will tell you.

I have had the HPV vaccine. Do I still need screening?

Yes. The vaccine greatly reduces the risk from the HPV types it covers, but it does not cover every high-risk type and does not treat an existing infection. Screening on the age-based schedule is still recommended.

Why does the HPV test with a Pap backup repeat every five years instead of three?

Because it checks both the virus and the cells, a normal result offers a longer window of reassurance. The swab-only options are repeated every three years.

Does a positive HPV result mean my partner was unfaithful?

No. HPV is extremely common, and an infection can stay quiet for years before it shows up on a test. A positive result cannot tell you when or from whom the virus was acquired, so it is not a sign of anything about a current relationship.

Do I still need screening after a hysterectomy?

It depends on why the hysterectomy was done and whether your cervix was removed. Many patients who had the cervix removed for a non-cancerous reason, with no history of significant cervical changes, can stop. Others still need screening. Bring your surgical history to your visit and your provider will tell you which applies.

Can I switch options from one screening to the next?

Yes. Choosing the self-collected test this time does not lock you in. At each screening you and your provider can decide which approach makes sense, and the interval follows the option you choose.

Choose Your Screening Option at Your Next Visit

If you are due for cervical cancer screening, or want to switch to a no-speculum option, schedule your annual visit online. If you are not sure when you were last screened, phone our Downers Grove office and our team can help you work out whether you are due.