Don't Panic After an Abnormal Pap
By Amy Zehnder, MD, Virtua Obstetrician and Gynecologist
An abnormal Pap test result can mean a number of different things. So, if the doctor’s office calls back a few days after your visit to the gynecologist, don’t panic.
The first thing you need to know is that a Pap test is only a screening, and does not offer a specific diagnosis.
As with any screening, there’s a potential for false positives. Any abnormal Pap result will require further testing to determine the root problem, if there is one.
Possible Pap Test Results
After a Pap test, the pathologist who analyzes your cell sample will report back to your gynecologist one of the following observations:
- Normal/negative (everything looks as it should)
- ASCUS (atypical squamous cells of undetermined significance)
- LGSIL (low-grade squamous intraepithelial lesion)
- HGSIL (high-grade squamous intraepithelial lesion)
The pathologist will also report any evidence of a bacterial or fungal infection; most commonly these would be candida (a yeast infection), trichomoniasis (a sexually transmitted infection), or gardnerella (the primary cause of bacterial vaginosis).
What Happens After Pap Test Results Come In?
If your Pap and HPV (human papillomavirus) test results comes back normal/negative, and you don’t have a history of abnormal Pap tests, then you don’t need to have another one for 3 years. You DO still need to have yearly pelvic exams though. If you're under age 26, you may benefit from the HPV vaccine as well, which protects you from high-risk strains of HPV that cause cervical cancer and genital warts.
If the result comes back in any of the other categories mentioned above, further diagnostic testing and possible treatment will be needed.
- If ASCUS
The same sample from your Pap smear will be tested for HPV. If it tests positive for HPV, your next step will be the same as a result that shows LGSIL. If, however, there is no evidence of HPV, you’ll just come back in another year for a repeat Pap test to make sure all is well.
- If LGSIL
If an LGSIL is suggested, the next step is a colposcopy. Having a colposcopy is similar to having a Pap test—it’s done in the office, and a speculum is used open the vagina, allowing the doctor to see the cervix. What's different is that a high-powered microscope is then placed near the vaginal opening that allows a very detailed view of the cervix and cervical cells. If the cells appear abnormal, and sometimes even if everything looks okay, we take a biopsy to confirm the diagnosis. If the biopsy reveals normal cells, nothing beyond routine screening is needed. If LGSIL is confirmed, we’ll do a repeat Pap in six months.
- If HGSIL
If an HGSIL is suggested by the Pap test and confirmed with colposcopy/biopsy, we need to remove those cells. A variety of procedures may be performed; LEEP (which stands for loop electrical excision procedure) is the most common, but cryotherapy (freezing the cervical cells) or laser treatment are also options. From there, your doctor will want to repeat Pap tests every 4-6 months.
- If an infection is present
A vaginal infection can be easily treated with an anti-fungal or anti-bacterial medication, depending on the type of infection it is. If, however, trichomoniasis is suspected, you'll need an STD test to confirm the diagnosis. Once confirmed, you'll need to be treated along with your sexual partner.
The Good News About HPV
You may be thinking, “Good news about HPV?” While it’s obviously not a cause for celebration, an HPV diagnosis doesn’t have to leave you frantic or afraid. Nearly all sexually active women get HPV at some point in their lives. But 80% of those women will find that the HPV clears from their body within 2 years of diagnosis. However, this makes regular Pap tests and visits to your gynecologist all the more important.
Cervical cancer doesn’t just happen overnight. In fact, the occurrence in the U.S. is so low because of routine screening with Pap tests, and because women are treated as soon as more significant intraepithelial lesions are detected.
Updated June 6, 2016