Discordant results between HPV DNA tests and HPV mRNA tests could have changed follow-up for 71.7% of patients who had one previous high-risk (hr) HPV-positive result, and 60% of patients who had at least two hrHPV-positive results (Obstet Gynecol 2018;0:1-7). The data expose the need for labs to specify the type of assay used in HPV screening, according to the authors, who also expressed hope that their findings “will start conversations between gynecologists and pathologists to be sure the HPV DNA test is used for primary screening to identify those at potential long-term risk.”

The researchers conducted a retrospective quality improvement study to assess the consistency between HPV mRNA and HPV DNA test results in women previously diagnosed with HPV infections based on HPV DNA testing. HPV DNA testing detects presence or absence of HPV infection but does not distinguish between active or latent infection. HPV mRNA testing detects E6 and E7 mRNA from E6/E7 oncoproteins necessary for cervical epithelial cells to become malignant. Presence of E6/E7 mRNA not only indicates active HPV infection but also correlates with histologic and cytologic abnormalities. However, HPV mRNA testing is less sensitive in detecting HPV infection.

Clinical guidelines recommend HPV DNA testing as a primary screening test, but “many pathology laboratories have shifted to using [this] assay without clear discussion with gynecologists about the effects on patient follow-up,” according to the authors.

Negative HPV mRNA results following positive HPV DNA results might have changed clinical management for 289 of 425 women age 30 or older whose test results were included in the study. Many women clear HPV infections without intervention within 6 to 18 months. However, among women with two prior positive HPV DNA results and a negative HPV mRNA result, 75% had at least one abnormal Pap test and 36.5% had at least one abnormal colposcopy. “This points to the strong possibility that these patients still have infection and need closer screening to prevent development of cancer,” the authors explained.