EFC Commentary on the New WHO Guidance on HPV DNA Genotyping in Cervical Screening
The World Health Organization (WHO) has recently published updated guidance on the use of HPV DNA genotyping in cervical screening programmes and clinical pathways following a positive HPV test. Released on 11 May 2026, the guideline complements the 2021 WHO recommendations on cervical screening and treatment and reflects the growing move towards risk-based management in HPV-based screening programmes.
The guidance evaluates how genotype-specific HPV information can be used to refine risk stratification after a positive HPV test and support decisions regarding referral, surveillance, and management of women at risk of cervical precancer. Three broad testing approaches are considered:
- No genotyping
- Limited genotyping (typically HPV16/18, with optional inclusion of HPV31/33/45)
- Extended genotyping
The EFC Perspective
The European Federation for Colposcopy (EFC) welcomes the publication of this important WHO guidance, which recognises the increasing role of HPV genotyping in risk-based cervical screening. As HPV-vaccinated cohorts enter screening programmes and the prevalence of CIN3+ declines, tools that improve risk stratification are likely to become increasingly important.
For European colposcopy practice, the principal value of HPV genotyping is likely to be in supporting clinical decision-making where the next management step is uncertain rather than directing treatment decisions. Potential applications include:
- Persistent oncogenic HPV positivity without high-grade cytological abnormalities
- Management of older HPV-positive women
- Surveillance following low-grade abnormalities
- Supporting decisions around conservative management of CIN2 in younger women
- Determining appropriate surveillance intervals following treatment or observation
While the WHO guidance identifies HPV16 and HPV18/45 as the highest-risk genotype groups, EFC emphasises that genotype results should be interpreted alongside cytology, vaccination status, previous screening history, colposcopic findings and, where indicated, histological assessment. In European practice, treatment decisions should continue to be based on established colposcopic and histopathological pathways rather than genotype alone.
An important aspect of the WHO guidance is the proposed grouping of HPV genotypes according to their attributable fraction in cervical cancer:
- Group 1a: HPV16
- Group 1b: HPV18/45
- Group 1c: HPV31, 33, 35, 52 and 58
- Group 1d: HPV39, 51, 56 and 59
This approach moves beyond the traditional concept of a single “oncogenic HPV-positive” category and reflects growing recognition that different HPV genotypes confer different levels of risk. It is also notable that HPV68 is not included within these grouped risk categories. These proposals are likely to stimulate discussion regarding the optimal extent of genotyping in European screening programmes and whether all currently reported genotypes provide clinically meaningful information within risk-based management pathways.
While EFC welcomes the publication of this guidance, its implementation in Europe should be considered within the context of organised national screening programmes, existing triage algorithms, colposcopy capacity, histological confirmation pathways and established European quality assurance standards. Any adoption of extended genotyping strategies should be supported by evidence of clinical benefit, cost-effectiveness and programme feasibility.
As HPV-based screening continues to evolve, colposcopy services will require clear referral protocols defining how genotype information should be incorporated into clinical pathways. The guideline also highlights the importance of quality assurance, outcome monitoring and effective communication with women regarding the significance and limitations of genotype-specific HPV results.
The implications of HPV genotyping for future colposcopy practice will undoubtedly be an important topic of discussion at the EFC Congress in Bucharest, 14–17 October 2026.