Pap Tests and HPV

What is a Pap test?

A Pap test screens for cancer of the cervix (the passageway between the vagina and the uterus). A Pap test can also be used to screen for non-visible (subclinical) human papilloma virus (HPV) infection. The Pap test is not a specific test for HPV, although sometimes the results suggest that HPV might be present.

A Pap test is a procedure performed by your clinician during which a sample of cells is collected from your cervix. Some individuals may experience minor discomfort with this procedure. It is a sensitive procedure and a chaperone will be provided. 

Cells are then sent to a laboratory and examined for any abnormal cells, which may be caused by HPV infection.

Several different systems are used to report the results of a Pap test. UHS uses a method called the Bethesda system (see Understanding Pap test results).

HPV infection of cervical cells can lead to changes in normal cell function and the formation of precancerous cells, a process called dysplasia. A Pap test can detect these abnormal cells. Since there are no signs or symptoms of dysplasia, it is important to get a Pap test if you are 21 years or older.

Individuals with abnormal Pap tests are examined further for cervical problems, usually with repeat Pap tests and/or a colposcopy. This procedure uses a magnifying scope that allows the clinician to see the cervix in great detail. Colposcopy also enables the clinician to take cell samples from suspicious-looking areas on the cervix for closer examination, called a biopsy. These procedures may cause minor cramping and minor pain. A colposcopy is a sensitive procedure and a chaperone will be provided.

Who should get a Pap test, and how often?

Pap tests are recommended to begin at age 21 for individuals who have a cervix. Frequency of testing depends on several factors. Your clinician will recommend testing based on your individual situation. 

Are Pap tests required before getting a prescription form of birth control?

Not necessarily. Your clinician will determine the need for a Pap test (and other services), based on your age and medical history.

What is human papilloma virus (HPV)?

HPV is the most common sexually transmitted infection (STI) among college students today. It is estimated that up to 50-60% of sexually active college-age individuals with a cervix are infected with HPV at some point during their college years.

There are more than 100 different types of the virus. Some types of HPV cause warts on hands or feet, others cause genital warts and some can have no visible symptoms at all.

When no visible symptoms of HPV are present, the infection is called subclinical. Most people with HPV do not know that they are infected and do not develop health problems from it.

Transmission:

HPV is usually transmitted through skin-to-skin sexual contact. The virus is not transmitted through body fluids. Condoms can decrease transmission by protecting skin but do not eliminate transmission. Intercourse is not necessary for transmission. See also Prevention.

Anyone who is sexually active can get HPV, even if you have had sex with just one person. You also can develop symptoms years after you have had sex with someone who has HPV. This makes it hard to know when you were first infected. 

Although the types of HPV that cause visible warts spread more easily, people infected with subclinical HPV, who show no signs of infection, are also contagious and can infect others. 

What is the relationship between HPV and cancer?

Several types of HPV that cause subclinical infection and dysplasia can develop into cervical cancer. However, cervical cancer is extremely rare among young adults because the body's immune system typically clears the infection.

Pap tests can identify early cell changes which can be treated before cancer develops. Regular Pap tests combined with appropriate follow-up treatment can practically eliminate the risk of developing cancer. See Prevention.

Other factors may increase the risk of cervical cancer, including:

  • Smoking
  • History of many sexual partners (or a partner with such a history)
  • History of sexually transmitted infections
  • Sex before the age of 21
  • Weakened immune system
  • Poor nutrition
  • The presence of other infections

Cervical cancer develops slowly, usually over many years. Any abnormal Pap test should monitored regularly by a health care provider (see Understanding Pap test results).

If the Pap test is mildly abnormal, more frequent Pap tests may be the only recommendation. If more severe cell changes are found, or if there are several atypical Pap tests, a colposcopy and biopsy will be recommended. If your biopsy confirms the presence of precancerous or cancerous cells, treatment may be appropriate. If cervical cancer is present and if left untreated, it may spread to other parts of the body and eventually cause death.

Treatment of subclinical HPV:

In 90% of cases, abnormal cells will disappear on their own without treatment.

Most experts say that there is no proven benefit to treating subclinical HPV infection that is not precancerous. While removal of abnormal cells may reduce the amount of virus in your system, it may also cause scarring on the cervix. It is important, however, that health care providers watch carefully for precancerous changes on the cervix that may be found along with HPV infection.

Treatment of precancerous cells or dysplasia, which may lead to cancer, is very important. The goal of treatment is to prevent the development of an actual cancer or prevent its spread to deeper tissues.

Options for treatment include electrosurgery, traditional surgery or laser surgery. It is important to discuss treatment options with a knowledgeable clinician to make an informed choice regarding your care and follow-up.

Prevention:

Get vaccinated against HPV. See HPV and Vaccination.

Get screened for cervical cancer as appropriate. 

Consider that more partners usually means more risk. Fewer partners may reduce risk of HPV. 

Condoms and latex dams will provide some protection but may not cover the entire affected area of the genitals, so some contact with infected skin can still occur. On the other hand, condoms are very effective at preventing transmission of other STI and should be used consistently with each sexual act.

Understanding Pap test results:

Pap test results are classified according to the Bethesda System, as follows.                

Within normal limits:       
Description: Only normal cells in sample
Recommendation: Return in 3-5 years for a routine Pap test

Atypical squamous cells of unknown significance:
Description: Most cells in sample are normal, but some cells have irregular colors, shapes, sizes
Recommendation: Treat any infection; may need colposcopy and/or repeat Pap tests

Low-Grade Squamous intrapithelial lesion (SIL):
Description: Some abnormal cells in sample; cancer is rare at this stage
Recommendation: May need colposcopy and/or repeat Pap tests; treat if necessary

High-Grade Squamous intrapithelial lesion (SIL):
Description: Large number of abnormal cells in sample
Recommendation:  Perform colposcopy and biopsy; treat if confirmed

Squamous cell carcinoma:
Description of cell sample: Sample contains cells that are probably cancerous
Recommendation: Perform colposcopy and biopsy; treat if confirmed

More information:

For more on HPV, see:

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