My HPV Test Was Positive: The National Screening Programme and Next Steps

If the message from your family doctor or from KETEM (Kanser Erken Teşhis, Tarama ve Eğitim Merkezi; Cancer Early Diagnosis, Screening and Education Centre) says “HPV positive”, the first reaction is often fear. Yet this result is not a cancer diagnosis; it is a sign that the neck of the womb (cervix) needs to be looked at more closely ¹. Human papillomavirus (HPV) is so common that almost all sexually active people come into contact with it at some point in their lives, and most never notice ². This article explains, in order, which steps the national screening programme in Türkiye sets out after a positive result and what the scientific sources say.

What does HPV positive mean?

HPV is the name of a family of viruses with around 200 known types; some of these are classified as “high-risk”, and the cause of cervical cancer is persistent infection with these types ². According to the World Health Organization (WHO), in 90% of people the immune system brings the virus under control on its own, and the infection usually clears without trace within a year or two ². In other words, for most women a positive result is a temporary encounter picked up in the laboratory; what really matters is monitoring over time whether the virus persists.

Even persistent infection does not turn into cancer overnight. The WHO reports that progression from HPV infection to cervical cancer usually takes 15–20 years; over this long period, precursor changes (precancerous lesions) first develop in the cells, and these usually cause no symptoms at all ². This is exactly the purpose of screening: to find precursor changes before they turn into cancer and, if necessary, to treat them with simple methods. In the WHO’s words, treating precancerous lesions prevents cervical cancer ². A positive result is a sign that this protective chain is working.

How does national screening work in Türkiye?

According to the National Standards of the Cervical Cancer Screening Programme of the Sağlık Bakanlığı (Ministry of Health), screening is offered every five years to women aged 30 to 65 inclusive; it is carried out by family health centres (ASM) and KETEMs ¹. In Van, too, the first place to go is the family doctor you are registered with or the provincial KETEM. Under the programme, no fee is charged for screening or, when needed, for colposcopy (examination of the cervix with magnification) ³. Results are sent online to the unit that took the sample; they can also be checked on the programme’s online results page using the barcode number given during the procedure and your T.C. identity number ⁴.

Taking the sample takes a few minutes; two kinds of sample are taken from each person: one for the HPV DNA test and the other for a smear test (Pap smear, cervical swab; cytology), to be assessed from the same visit if needed ⁵. The samples are analysed in central laboratories in Ankara and İstanbul; the standards provide for the person to be informed about the result and the next steps within 20 days at the latest ^1,5. In the first one million women screened, HPV positivity was 3.5%, and the most common types were, in order, 16, 51, 31, 52 and 18 ³. In other words, the result was negative in about 95 out of every 100 women, and in 1.4% the test was repeated because the sample was inadequate ³.

What happens after a positive result?

The national algorithm divides positive results into two groups. If HPV type 16 or 18 is detected, the woman is referred directly to a colposcopy centre ^3,5. For other high-risk types, the smear sample taken at the same visit is examined (reflex cytology); if the smear shows an abnormality of ASC-US (mild cell changes of uncertain significance) or higher, colposcopy is again recommended ^1,3. The national standards put it clearly at this point: an abnormal result “is not a cancer diagnosis, but shows that the person needs to be assessed again”, and the person is referred to an obstetrics and gynaecology specialist at a higher-level centre ¹. In the evaluation of one million women, the rate of referral to colposcopy was 1.6% ³.

At colposcopy, the doctor examines the cervix with a magnifying device; if a suspicious area is seen, a small tissue sample (biopsy) may be taken in the same session ³. Under the programme, there is at least one colposcopy centre in every province ³. Of the first 3,499 women in the same evaluation who were referred to colposcopy and whose results were reported, 1,985 had a normal result; mild changes (CIN1) were found in 708, precancerous lesions that may need treatment (CIN2 and CIN3) in 721, and cancer in 85 ³. So more than half of the women in this group had no significant finding; being called for colposcopy does not mean having cancer.

Follow-up intervals: when is the test repeated?

For women whose smear is normal and who are positive for an HPV type other than 16/18, the main tool is time. Türkiye’s national algorithm provides for the HPV test to be repeated after one year in this group ^5,6. The WHO 2021 guideline, on the other hand, recommends that women with a positive HPV DNA test but a negative second-stage (triage) test be retested after 24 months, returning to the usual screening interval if the result is negative ⁷. In Türkiye, the reference point is the programme’s one-year recall; your doctor plans your follow-up according to your age, your previous results and your immune status. Women with a negative result are advised to be screened again after five years; if the sample is inadequate, the test is repeated ^1,5.

For women in whom precancerous lesions (CIN2 or CIN3) have been found and treated, the WHO recommends a check with an HPV DNA test 12 months after treatment and, if it is negative, a return to the usual interval ⁷. Precancerous lesions can be treated by freezing or heat cautery (ablation) or by minor surgical procedures; the WHO emphasises that these treatments prevent cervical cancer ². There is, however, currently no medicine that eliminates the HPV infection itself; treatment is aimed not at the virus but at the cell changes it causes ². For this reason, it is worth being cautious about products offered with the promise of a “cure that clears HPV”.

What you can do for yourself during this time

Not smoking, or stopping smoking, reduces the likelihood of persistent HPV infection; condoms reduce transmission but do not give full protection, because they do not cover all of the genital skin ². A positive result carries no judgement about faithfulness in the relationship: almost all sexually active people come into contact with HPV at some point in their lives, and the virus can remain for years without causing symptoms ²; so a positive result does not show when the virus was acquired. The WHO recommends that the HPV vaccine be given to girls aged 9–14 before they become sexually active; the vaccine does not treat an existing infection, it aims to prevent future cancers ².

According to WHO data, around 660,000 women worldwide were diagnosed with cervical cancer in 2022; it is the fourth most common cancer in women, and most of the burden falls on countries where access to screening and vaccination is limited ². The symptoms of this cancer — bleeding outside periods, bleeding after sex, foul-smelling discharge — can also be caused by other conditions; precancerous lesions, however, usually cause no symptoms at all ². That is why not putting off the test when you are invited every five years after the age of 30, and taking the recommended step promptly after a positive result, is the way of preventing this cancer that has been shown to be effective ^1,7.

If you have symptoms, please see an obstetrics and gynaecology specialist.