Genotype-specific HPV persistence is the most important determinant of cervical cancer risk in women who test HPV-positive, regardless of HPV genotype1-4

If a woman tests positive for HPV during routine screening, there are three possible outcomes for her next HPV test result:


the next test result will be HPV negative. This is the most likely outcome as over 90% of HPV infections are cleared by the immune system within 6-18 months5

Type switch

the next test result will be HPV positive, but for a different HPV genotype

Genotype-specific HPV persistence

the next test result will be HPV positive for the same HPV genotype

HPV51HPV-HPV +ClearanceType SwitchGenotype-specificHPV persistenceaka Type PersistenceTest 1Test 2HPV51HPV52HPV +HPV51HPV51HPV +HPV +HPV +

If the immune system does not clear the infection, it is important to determine if it is a “type switch” or “type persistence”, because studies have found that women who switch HPV genotype are at a reduced risk of developing cervical cancer as compared to women who have genotype-specific persistence.2

All women (40/40)
with persistent genotype-specific HPV infection developed CIN2+ disease
No women (0/35)
who switched HPV genotypes or cleared the infection developed CIN2+ disease

Cumulative proportion of ≥CIN2 among women with genotype-specific HPV persistence*

0102001234567304050607089101112138090100 Time in years since baseline screening Type PersistenceCumulative incidence of CIN2+ (%)Unknown persistence statusClearance Type Switch

Adapted from Elfgren et al. Am J Obstet Gynecol. 2017;216:264.e1-7.
*12,527 women aged 32-38 years with follow up of 195 women attending colposcopy who were cytologically normal but persistently HPV positive for at least 1 year.
However, not all HPV assays allow for tracking of genotype-specific persistence.

Monitoring genotype-specific HPV persistence is key to identifying your patients at most risk for developing cervical disease.2,4,6

Extended genotyping provides individual results for at least 5 hr-HPV genotypes7 meaning that from one HPV test to the next, it is possible to get the specific HPV genotype result and therefore determine if it is genotype-specific HPV persistence or type switch.

Partial genotyping
cannot identify genotype-specific persistence beyond HPV 16 & 18

31 ? 68 ? 59 ? 52 ? 66 ? 56 ? 39 ? 45 ? 51 ? 51 ? 35 ? 33 ? 31 ? 68 ? 59 ? 52 ? 66 ? 56 ? 39 ? 45 ? 51 ? 51 ? 35 ? 33 ? HPV+HPV+Test 1Test 2

Extended genotyping
can identify genotype-specific persistence beyond HPV 16 & 18, and type switch

Type Switch Genotype-specific HPV persistenceaka Type PersistenceHPV51Test 1Test 2HPV52HPV +HPV51HPV51HPV +HPV +HPV +

CIN, cervical intraepithelial neoplasia; HPV, human papillomavirus; hr, high risk

1. Bonde JH et al. J Low Genit Tract Dis. 2020;24(1):1–13.
2. Elfgren et al. Am J Obstet Gynecol. 2017;216:264.e1–7.
3. Radley D et al. Hum Vaccin Immunother. 2016;12(3):768–72.
4. Bodily J, Laimins LA. Trends Microbiol. 2011;19(1):33–9.
5. Mitra A et al. Microbiome. 2016;4:58.
6. Perkins RB et al. J Low Genit Tract Dis. 2020;24:102–31.
7. Bonde J et al. J Clin Virol. 2018;108:64–71.