Pap Smears and HPV

Note: UHS offers HPV vaccine through the Allergy, Immunization and Travel Health Clinic. For details, see HPV and Vaccination.

On this page:

• What is a Pap smear?
• How often should women get Pap smears?
• Are Pap smears required before getting a prescription form of birth control?
• What is human papilloma virus (HPV)?
• Transmission
• What is the relationship between HPV and cancer?
• Treatment of subclinical HPV
• Prevention
• Understanding Pap smear results
• Further information

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

A Pap smear is a procedure performed by your clinician during which a sample of cells is taken from your cervix using a small brush or swab.

This procedure is usually painless, although some women may experience minor discomfort. Cells from the Pap smear are then examined for any abnormal microscopic appearances, which can include changes caused by HPV infection. There are several different systems used to report the results of a Pap smear. UHS uses a method called the Bethesda system (see Understanding Pap smear results).

HPV infection of the cells on the cervix can lead to changes in normal cell metabolism and the formation of precancerous cells, a process called dysplasia. A Pap smear can detect these abnormal cells. Since there are no signs or symptoms of dysplasia, it is important to get a Pap smear regularly if you are sexually active.

Women with abnormal Pap smears are examined further for cervical problems, usually with repeat Pap smears 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. There are also several new DNA tests that can detect the genetic material of HPV in women. These are used to verify cervical HPV infection and identify the viral type in a small number of cases. 

How often should women get Pap smears?  Current recommendations (unless certain risk factors are present) are:

• For women ages 21-29: Every two years if your prior Pap smear is negative for abnormal cells
• For women ages 30 and older: Every three years if your prior Pap smear is negative for abnormal cells and high-risk HPV

Are Pap smears required before getting a prescription form of birth control? Not necessarily. Your clinician will determine the need for a Pap smear (and other services), based on your age and medical history.

What is human papilloma virus (HPV)? HPV is the most common sexually transmitted disease (STD) among college students today. It is estimated that up to 50-60% of sexually active female college students 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, especially those with a subclinical infection, do not know they have it. It is estimated that 70% of individuals with HPV may be unaware that they are infected because they do not develop visible warts or abnormalities on their Pap smears.

Transmission:: HPV is usually contracted through vaginal and/or anal sex. It is possible for it to be contracted through oral sexual contact. Direct skin-to-skin contact easily spreads the infection--the virus is not transmitted throuhg blood or body fluids. Actual intercourse with penetration is not necessary to transfer this infection. Transmission can occur with same sex or opposite sex partners. 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. There is at least a 64% chance of contracting HPV with each act of unprotected sex with an infected partner.

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 immune response is effective in most cases. Early changes are found on Pap smear results and can be treated before cancer develops. Regular Pap smears combined with appropriate follow-up treatment can practically eliminate the risk of developing cancer.

Certain other factors may increase the risk of cervical cancer, the most common of which include: a history of many sexual partners (or a partner with such a history), a history of sexually transmitted diseases, sex before the age of 21, a weakened immune system, smoking, poor diet, or the presence of other infections. Using a condom during sexual activity may decrease the risk of cervical cancer.

Cervical cancer does not develop overnight. Precancerous and cancerous changes usually occur over a period of many years. Regular Pap smears may be used to monitor HPV infections that seem likely to lead to cervical cancer (see Understanding Pap smear results).

If the Pap smear is mildly abnormal, more frequent Pap smears may be the only recommendation. If more severe dysplasia is found, or if there are several atypical Pap smears, 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: 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. In the majority of cases, abnormal cells will disappear on their own without treatment. 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: You can reduce your risk of contracting HPV by not having sex or genital contact with anyone or by limiting your number of sexual partners. People with many sexual partners have a greater risk of contracting HPV and other STDs. Condoms and latex dams will provide some protection but may not cover the entire affected area of the genitals, thus some contact with infected skin can still take place. On the other hand, condoms are very effective at preventing the spread of other STDs and should be used consistently with each sexual act. See also HPV and Vaccination.

Understanding Pap smear results:

Further information:

See also HPV and Vaccination.

If you have questions, ask your health care provider. If you are a UM student or a patient at UHS, call your Clinician or call the Women's Health Clinic at 734-763-9184.

For more information about HPV, see American Social Health Association