Fast Facts - HPV PCR Screening

PATHCHAT Edition
Published: 2024
Please contact your local Ampath pathologist for more information.

Why is Cervical Cancer Screening Important?

✅ Primary Goal of Screening

• Detect unsuspected cervical cancer or precancerous lesions early.
• Increase treatment success rates and improve patient outcomes.
• Cervical cancer is highly preventable with regular screening.

✅ HPV and HIV Co-Infection in South Africa

• High prevalence of co-infection contributes to more rapid cervical cancer progression.
• HIV-positive women require more frequent screening.

📌 Cervical cancer screening is necessary for all women, regardless of HPV vaccination status.

Why Use HPV PCR Testing for Cervical Cancer Screening?

✅ HPV PCR vs. Cytology

• HPV PCR detects pre-cancerous and cancerous lesions with higher sensitivity than cytology:
  • HPV PCR: 94.6% sensitivity.
  • Cytology: 55.4% sensitivity.
• Better negative predictive value compared to cytology, allowing longer screening intervals.

📌 HPV PCR is the recommended primary screening method by the WHO and South African guidelines.

Primary Screening Recommendations Using HPV PCR

General Female Population

• Age at initiation: 25–30 years.
• Frequency: Every 5–10 years.
• Negative HPV DNA result: Continue regular screening.
• Positive HPV DNA result: Follow either:
  • Screen-and-treat approach.
  • Screen-triage-and-treat approach.

HIV-Positive Patients

• Age at initiation: 25 years.
• Frequency: Every 3–5 years.
• Positive HPV DNA result: Follow the screen-triage-and-treat approach.

📌 Women may exit screening at 50 years after three consecutive negative HPV PCR tests, or at 60 years if any abnormal result was previously detected.

HPV PCR Testing at Ampath

✅ Test Details

• Ampath offers high-risk (hr) HPV PCR testing with partial genotyping.
• HPV types detected:
  • Individually typed: HPV 16 and HPV 18.
  • Combined result for other high-risk HPV types:
    • Types 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68.

📌 Partial genotyping helps stratify risk and determine appropriate follow-up strategies.

Interpreting HPV PCR Results

✅ Risk-Based Classification

1. Low Risk:
   • HPV PCR negative.
2. Intermediate Risk:
   • Positive for high-risk HPV types (other than 16, 18, or 45).
3. High Risk:
   • Positive for HPV type 16, 18, or 45 (if specified in partial genotyping assay).

✅ Management Based on Risk Level

• Low-risk patients: Routine follow-up screening at recommended intervals.
• Intermediate-risk patients: Require additional triage with colposcopy, cytology, or visual inspection with acetic acid (VIA).
• High-risk patients: Require urgent colposcopy and further management.

📌 HPV 16, 18, and 45 carry the highest risk for cervical cancer development.

HPV PCR Sample Collection & Testing Options

✅ Sample Collection Methods

• Flocculated vaginal swab: Allows for patient self-collection.
• Liquid-based cytology:
  • Enables co-testing with cytology.
  • Reflex testing can be performed if HPV PCR is positive.

✅ Ordering and Costs

• Mnemonic: HPV
• Cost:
  • R500 (cash price).
  • Medical aid rates apply if claimed through a scheme.
• Turnaround Time: 48 hours from receipt in the laboratory.

📌 Patients can opt for self-collection or clinician-collected samples for HPV PCR testing.

Key Takeaways for Clinicians

✅ HPV PCR is the preferred method for cervical cancer screening due to its high sensitivity.
✅ Screening intervals can be safely extended for HPV-negative women.
✅ HPV-positive women require further triage with colposcopy, cytology, or VIA.
✅ High-risk HPV types (16, 18, 45) require urgent follow-up.
✅ HPV PCR testing can be performed via self-collection or clinician-collected swabs.

📌 For HPV PCR test requests or consumable orders, contact your local Ampath representative.