Human Papillomavirus (HPV) testing prior to HPV vaccination is not recommended unless HPV tests are part of the established local routines for cervical cancer screening. The reasoning is based upon the very low frequency of women who, at the time of vaccination, would show markers of prior/current exposure (HPV DNA or serological tests) to the HPV types included in the vaccine. Thus at least one thousand women would need to be screened to find one that is HPV 16 and 18 DNA positive. The increase in cost and the other barriers afforded by a prior to vaccination test requirement would result in a lower coverage, the key indicator of a successful vaccination program.