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What’s Next if You Have an Abnormal Pap Smear

By Elizabeth Shy, MD, Obstetrician and Gynecologist
Virtua OB/GYN – Westampton and Southampton

An abnormal Pap smear result can mean many different things. So, if you get a call a few days after you visit the gynecologist, try not to panic.

You need to know that a Pap test is only a screening—it doesn't give you a specific diagnosis. As with any screening, there's a potential for false positives. If you get an abnormal Pap smear result, you'll require further testing to determine if there's an issue that needs to be addressed.

What's most important is that you have an annual OB/GYN exam so you can catch issues early when they're most treatable.

Possible Pap test results

The purpose of a Pap test is to screen you for cervical cancer or to look for precancerous changes in cervical cells. After a Pap test, the pathologist who analyzes your cell sample will report one of the following observations to your gynecologist:

  • 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 also will report signs of a bacterial or fungal infection, such as candida (a yeast infection), trichomoniasis (a sexually transmitted infection), or gardnerella (the primary cause of bacterial vaginosis). 

Your gynecologist may also do an HPV test with your Pap test to look for human papillomavirus. HPV is a common sexually transmitted infection that causes cervical cancer and genital warts. 

What happens after Pap test results are returned?

It's important to know that Pap test results can be complex. Beyond the pathologist's report, your gynecologist also factors in your medical and HPV history and your age before meeting with you to recommend treatment or additional screening. The following explains what the test results can mean: 

Normal/negative results

  • If your Pap and HPV test results come back normal/negative, and you don't have a history of abnormal Pap tests, you may not need another one for 3 to 5 years.
  • You still need to have yearly pelvic exams.
  • If you're under age 45 and haven't already received it, it's recommended you get the 2-shot HPV vaccine, Gardasil, which protects you from high-risk strains of HPV. 

Further diagnostic testing and possible treatment will be needed if the result is anything other than normal/negative.

ASCUS (atypical squamous cells of undetermined significance)

  • 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 there's no evidence of HPV, you'll come back in 3 years for a repeat Pap test to make sure all's well.

LGSIL (low-grade squamous intraepithelial lesion)

  • If LGSIL is suggested and HPV is negative, a repeat Pap smear is recommended in 1 year.

LGSIL is suggested and HPV is positive, the next step is a colposcopy.

  • A colposcopy is an in-office procedure that's similar to having a Pap test.
  • A speculum is used to open the vagina, allowing the doctor to see the cervix.
  • A high-powered microscope is then placed near the vaginal opening so the gynecologist can see a detailed view of the cervix and cervical cells.
  • The gynecologist may take a biopsy to confirm the diagnosis.
  • If the biopsy reveals normal cells or LGSIL, a repeat Pap smear in 1 year is recommended.

HGSIL (high-grade squamous intraepithelial lesion)

If an HGSIL is suggested by the Pap test or diagnosed with colposcopy/biopsy, removal of the cells is necessary. Your gynecologist can remove the cells in a few ways:

  • LEEP (which stands for loop electrical excision procedure)
  • Cryotherapy (freezing the cervical cells)
  • Laser treatment

After treatment, your doctor will want to repeat your Pap tests every 4-6 months.

If an infection is present

  • Depending on the type, a vaginal infection can be treated easily with anti-fungal or anti-bacterial medication.
  • If trichomoniasis is suspected, you and your sexual partner both will need treatment.

The good news about HPV

You may be thinking, "Good news about HPV?" While it's not a cause for celebration, you don't need to be afraid of an HPV diagnosis.

Nearly all sexually active women get HPV at some point in their lives, but 80 percent will find that the HPV clears from their bodies within 2 years of diagnosis. However, this makes regular Pap tests and annual visits to your gynecologist all the more important. 

Cervical cancer doesn't just happen overnight. Occurrence in the U.S. is so low because routine screening with Pap tests allows prompt recognition and treatment of abnormalities. Additionally, the occurrence is lower because of routine HPV vaccination, which prevents infection with the highest risk strains of the virus.

Make your annual OB/GYN exam a priority

Find a Virtua OB/GYN near you and schedule an appointment online. Or, call a Virtua women's health navigator at 844-896-6367 to connect with a specialist who can help.

Updated November 22, 2021

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