Abornal Pap Smear

My Pap test came back abnormal.  What does that mean?  

An abnormal Pap test result means that some unusual cells were observed in the samples collected from the cervix. Such cells may indicate an infection, a precancerous condition or possibly cancer. However, a Pap smear is just a screening test. It is not 100% accurate. It may suggest a precancerous condition when in fact everything is normal.

Further testing through additional Pap smears, colposcopy, specific screening for sexually transmitted infections may be necessary to accurately diagnose and properly treat the condition.   Your provider should give you recommendations about which tests and treatments should follow.

If there is evidence of an HPV infection , a colposcopy will be typically be done to examine and confirm HPV infection by taking tissue samples from abnormal-looking areas. A gentle scraping from inside the cervix (endocervical canal curettage) may be done to obtain a sample of cells from “higher up.” These procedures help make a definite diagnosis, which is essential in deciding if further treatment is necessary. 

What is dysplasia?

Cervical dysplasia is a term that has been used to describe abnormal cells on the surface of the cervix, which may be detected through a Pap smear.   In dysplasia, normal cervical cells undergo a series of changes in their appearance. These changes can be classified as mild, moderate or severe.  

Cervical dysplasia is not the same as cervical cancer.   However, it is considered to be a precancerous condition. It can take 10 years or longer for cervical dysplasia to develop into cancer.   This is why getting screened on a regular basis is important; screening can catch any potential problems before they progress. Dysplasia can be detected from a Pap smear.   Thus most physicians recommend that suspicious cervical lesions be removed and followed-up with frequent Pap smears to monitor for recurrences.

My Pap test just came back abnormal.  What does that mean for my current, past or present sexual partners?  

If you have had an abnormal Pap smear, this is most likely an indication that you have been infected with HPV (human papilomavirus ) or another sexually transmitted infection, meaning that one or more of your previous sexual partners was infected with HPV or another sexually transmitted infection.  However, a Pap test can come back abnormal for a number of other reasons.  It may be that the cell sample collected had irregularities because you used a vaginal douche and had intercourse within 48 hours of your Pap test.   It could be that you have cellular changes on the cervix because of something not related to your sexual activity, such as tobacco use, nutritional intake, or DES exposure.  Follow up tests will help indicate why your Pap smear came back abnormal. Remember, a Pap test is just a screening test.  Talk with your provider to determine what additional testing should be done to determine the exact type of treatment and follow-up is needed.

If your abnormal Pap test is the result of an HPV infection, it is difficult to determine when you were infected, or who you might have gotten the infection from, if you’ve ever had more than one sexual partner, because cellular changes happen rather slowly on the cervix.

Therefore, you may choose to contact previous and/or current partners to let them know that they may be infected with a high-risk strain of HPV.  However, there is no legal requirement that you do so, and due to the slow nature of cellular changes, you may have been infected years before, so there is no way of knowing exactly when you contracted the virus.   Likewise, you may decide to inform future partners (male or female) that you have a history of HPV infection.   However, every individual must decide what feels right for them based on what we know about HPV.   Some things to consider:

Unfortunately, research has shown that the HPV test may lead to inconsistent results with men. This is because it is difficult to get a good cell sample to test from the thick skin on the penis.   Thus, it is difficult for a particular man to confirm whether he is infected with a specific HPV strain.

Most people do not have visible symptoms if they are exposed to HPV.  Therefore, many people who have HPV pass it on to their partners without even knowing they have it.  

If a male is exposed to one of the high risk strains of HPV that cause cervical changes in women, he would be unlikely to have symptoms. In fact, most of the time, men will not have any health risks associated with the strains of HPV that cause cervical cancer.  

The HPV vaccine (Gardasil) is not currently approved for use in men.   The manufacturer is currently doing research on the vaccine’s effectiveness in men, but at this time, the vaccine is only approved for women, ages 9-26.  

Given these facts, the medical field has focused most of its attention related to HPV on women and the need to ensure they have regular Pap smears.     Ultimately, it is primarily the woman’s cervix that needs to be monitored, regardless of which of her partner(s) may have HPV.  

Therefore, men who know or suspect that they may have a strain of HPV that causes cellular changes should encourage their female partners to get Pap smears on the recommended schedule.   Also, women who have had an abnormal Pap smear and have sex with other women should be sure to continue to have their partners undergo regular Pap smears to monitor any potential cervical changes, since HPV can be passed through any close skin-to-skin contact during sexual activity.  

Can partners reinfect each other?

Reinfection with the same type of HPV is unlikely.   However, there are not currently any studies that have examined the effects of reinfection or the effects of treatment on infectivity.   Partners likely share the same strain of HPV though, and exposure to the same HPV strain(s) does not appear to cause a person to experience more symptoms.   The important thing is for women to continue to have Pap smears done at the recommended intervals, particularly after they have had an abnormal Pap test.

Will HPV affect a future pregnancy or baby?

Most treatments for cervical dysplasia will leave the cervix intact enough to preserve fertility.

During pregnancy, warts and lesions may grow faster.   Warts may have to be removed if they are bleeding or obstructing the birth canal.   HPV is rarely passed from mother to child.

Is it normal to feel upset about an abnormal Pap smear and/or HPV?

Yes, it is normal. Some people feel very upset when they learn their test results and learn more about what they mean. They feel may ashamed, fearful, confused, less attractive or less interested in sex. They feel angry at their sex partner(s), even though it is usually not possible to know exactly when or from whom the virus was spread. Some people are afraid that they will get cancer, or that they will never be able to find a sexual partner again. It is normal to have all, some or none of these feelings. It may take some time, but it is important to know that it is still possible to have a normal, healthy life, even with HPV.  

If you are looking for some support to help cope with HPV emotionally, check out the resources below.

Where can I go for more information and support?

Duke students who want additional information about HPV, abormal Pap smears, dysplasia, and/or colposcopy can make an appointment to see a Health Education Specialist one-on-one at the Student Health Center.  The health educator is available to answer any of your questions about abnormal Pap tests, as well as any other reproductive health issues that you would like to know more about.  

To make an appointment, call 919-681- WELL and ask to schedule an HPV consultation with Lindsey Bickers Bock.

Online resources:

The National HPV and Cervical Cancer Prevention Resource Center
Resource Center Hotline: 1-800-227-8922, Monday – Friday, 9:00 AM – 6:00 PM, Eastern Time
Online HPV Chat Room: 5:00 – 6:00 PM Eastern Time, Tuesdays and Thursdays
HPV e-News: Published six times a year via a secure Web page

Reviewed by the Office of Health Promotion, August 2006.