HPV FDA Approved screening:
women ages 21 years and older = Pap, reflex to Aptima HPV if ASC-US
women ages 30 years and older (ACOG limits age to 65) = Pap + Aptima HPV
Practice-preferred approach — Guideline allowed and FDA approved:
Women ages 21–29:
Pap, reflex to HPV testing if ASC-US
(Testing every 3 years, if results are negative)
Women ages 30-65:
*Co-Testing every 5 years: Pap + HPV
1. All HPV-positive results are reflexed to genotyping for HPV 16 and 18/45.
(co-testing every 5 years if results are negative)
Chlamydia and Gonorrhea testing:
all sexually active women ages 15-25
women at increased risk for Chlamydia and Gonorrhea
*Rationale: Current national guidelines (ACS, USPSTF's 2024 draft update, and HRSA's Women's Preventive Services Guidelines) now list primary HPV testing alone every 5 years as the preferred option, with co-testing and Pap-alone offered as acceptable alternatives. Our practice recommends co-testing over primary HPV-alone screening, particularly at 5-year intervals, for the following reasons:
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An HPV-positive result indicates the virus is present — it does not indicate whether cytologic damage has already occurred or how advanced any lesion may be.
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HPV infection can cause cellular changes and later become latent (non-replicating and not producing the oncoproteins that drive those changes) before a subsequent screening. A latent infection can test HPV-negative on a DNA or mRNA assay even though the virus caused damage earlier and a lesion is present.Because latent HPV is non-replicating and not producing the proteins that drive cellular changes, both the DNA test and the Pap test are designed to miss it ScienceInsights
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Real-world data support this concern: a large Quest Diagnostics/UPMC study of women who went on to develop cervical cancer found that HPV-alone testing failed to detect twice as many women who developed cervical cancer as co-testing did, with cotesting positive in 86.9% of cases prior to a cancer diagnosis — a non-detection rate of about 13.1% for co-testing (implying a substantially higher miss rate for HPV-alone). Quest Diagnostics
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The Pap component of co-testing adds detection value the HPV test cannot: while HPV tests are less likely to miss cases of CIN2+/CIN3+, they lead to more unnecessary referrals, and a negative HPV test is more reassuring than a negative cytology test, since cytology has a greater chance of a false negative — meaning the two tests catch different failure modes, and relying on either alone leaves a gap the other closes. PubMed Central
References
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American Cancer Society. Cervical Cancer Screening Guidelines. cancer.org/cancer/types/cervical-cancer/detection-diagnosis-staging/cervical-cancer-screening-guidelines.html
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U.S. Preventive Services Task Force. Draft Recommendation Statement: Cervical Cancer Screening (Dec. 10, 2024). uspreventiveservicestaskforce.org
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Health Resources and Services Administration / Women's Preventive Services Initiative. Update to the Women's Preventive Services Guidelines, Federal Register (Jan. 5, 2026). federalregister.gov/documents/2026/01/05/2025-24235
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ACOG. Updated Cervical Cancer Screening Guidelines (Practice Advisory, joint with ASCCP/SGO). acog.org
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Quest Diagnostics / UPMC. HPV Test Misses Twice as Many Women Who Develop Cervical Cancer as Co-testing (Health Trends™ study, July 8, 2020). newsroom.questdiagnostics.com
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Kaufman HW, et al. Cytology versus HPV testing for cervical cancer screening in the general population. Cochrane Database Syst Rev — summarized in PMC6483676.
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Can HPV Be Dormant and Test Negative? ScienceInsights, Nov. 2025. scienceinsights.org
1. We automatically reflex to genotyping for the oncogenic types 16 and 18/45 for HPV positive cases. These genotypes are responsible for 75% of all squamous cell cervical cancers and 94% of cervical adenocarcinomas. https://www.medscape.com/viewarticle/731407
ASCCP treatment and testing Guidelines:
http://www.asccp.org/guidelines
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