Separate scraping for hpv test (Digene hc2)?

Ladies, it has always been my understanding that the Digene hc2 is run from the same test (scraping/sample) as the pap. I thought that's why they call it "reflex testing"...in that most doctors will run hpv in the presence of an abnormal pap. I have never gone back for a second sample or had more than one sample taken.

Now I am finding information from other ladies who had two separate scrapings (one for pap, and one for hpv testing, specifically and separately) saying this is the CORRECT way to obtain the most accurate sampling and results?

Is my understanding not correct? Can it be done both ways and if so, which is better? Better yet, can someone point to an article detailing the PROPER collection method?

I am feeling so unsettled because I thought I could rely on my two combined pap+hpv tests, same sample, but information I have gotten from other very informed ladies suggests otherwise (in that their doctors say a more accurate hpv test is run from a separate sample and they are the ones who have been to teaching institutions, not me).

This would also apply to my recent anal smear, too.

Could you all please assist/comment. Thanks much.

By corellin
Posted June 18, 2009 at 1:54 pm
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Hi brie -- I think it depends on what method is used to collect the pap. The liquid paps provide a sample that can be used for both the HPV DNA test and the pap smear. But I don't think it's possible to use the conventional pap to do both at once (but I'm not sure).

I'm curious, though, what those other ladies say, because maybe there's something I haven't heard of. It doesn't seem to me, though, theoretically, that taking two samples would be more accurate. Seems to me it would increase the likelihood there would be a discrepancy between pap and HPV test to take two samples, if they were taken from two different spots -- since you might have HPV in one spot, but not another, if you had very, very low levels of HPV. At high levels of HPV, it's probably sheddding enough that viral particles would be more wide-spread and more likely to catch it in most, if not all, samples. I would prefer they both be run off the same sample.

Attached is a link to the Digene company website where they say: "How is the digene HPV Test done? Does it require any additional procedures?
The digene HPV Test can be done by any laboratory, usually using the same sample of cervical cells collected for the Pap. It does not require any additional time or discomfort on your part."

http://www.thehpvtest.com/About-the-digene-HPV-Test/HPV-Test-vs-the-Pap-FAQ s/Over-30.html#How-is-the-digene-HPV-Test-done

alwayssmiling - the Digene HC2 test is the common test approved by the FDA to check for HPV DNA at the cervix in a woman (usually done along with the pap smear). It checks for 13 high risk types and there's also a Digene test that will check for certain low risk types.

One thing to know -- the Digene test can "cross react" with other HPV types that are not among the 13, and it's possible for you to show "high risk" positive, even when you do not have one of the 13 defined as high risk. There are some types, such as HPV67 (an "undetermined" type) or others that are classified as low risk that will sometimes (in some percentage of cases), cause the HC2 test to be positive. For example, HPV67 "cross reacts" and shows high risk positive about 50% of the time. I know, because this happened to me!! And it took me about 5 months to finally come across a research paper that listed all the types that cross react and the percentage of time they cross react.

By brieaukirsch
Posted June 18, 2009 at 6:53 pm
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Corellin, thank you! I did some more research last night (very late last night, lol) and came across the same findings to the same conclusions. I'd rather the same sample was used as well. I think some of the other ladies might have had a separate ECC and/or a conventional pa with something else shipped for hpv testing. It can be done both ways, according to a CAP article I read.

Here's something WILD--according to that CAP article (which I didn't bookmark...grr...must find it again) women who have BOTH low and high risk hpv are at a much LOWER risk for cervical cancer than women with "only" high risk! It's like the more infested you are, the better, as long as you have both types!

By brieaukirsch
Posted June 18, 2009 at 11:28 pm
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Oh, Ariel--I'm so sorry. I didn't mean to imply that having both low and high risk hpv means you won't develop cc. I was just pretty well astounded at this CAP article that said women who had both types (simultaneously, I would imagine) were at much lower risk. I thought common sense would have dictated otherwise in that the more infections you have, the harder to fight them off--but maybe the low risk hpv when present helps prevent the high risk from hijacking your cellular division. Let me try to find that again--you may well disagree and there are NO absolutes in all this.

By corellin
Posted June 19, 2009 at 10:05 am
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Brie -- it's persistence of a single type that usually leads to cancer (because most people clear all the other types, but one). It's possible that the presence of multiple HPV types indicates more recent infection with HPV and is a marker that the person hasn't had HPV for that long. Unless they're looking for antibodies (which very often don't even show up) -- how would they know whether a person had ever been infected with both types?

But -- interesting article. I'd love it if you could find it again. I do that all the time (find an interesting article and then lose it).

Welcome to Inspire!

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