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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.
Your clinician will determine whether you need a pelvic exam and Pap smear, based on your
age and medical history. You should have routine Pap smears if you:
- Are 21 or older, or
- Became sexually active at least three years ago, even if you are younger than 21 or
are not currently sexually active
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.
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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, but unlikely, 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.
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Treatment of subclinical HPV Some 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. The clinician must often seek to remove not only the abnormal cells but some of the
surrounding tissue as well.
Options for treatment include electrosurgery, traditional surgery, laser surgery or cryotherapy.
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, including HPV, and should be used consistently with each sexual
act. See also HPV and Vaccination.
Understanding Pap smear results
Bethesda System
Classification |
Description of Cell
Sample |
Follow-up
Recommendation |
| Within normal limits |
Only normal cells in sample |
Return in one year for a routine Pap smear |
| Atypical squamous cells of unknown significance |
Most cells in sample are normal, but some cells have irregular colors, shapes, sizes |
Treat any infection; perform colposcopy and/or repeat Pap smears |
Squamous intrapithelial lesion (SIL):
- Low-Grade SIL |
Some abnormal cells in sample; cancer is rare at this stage |
Perform colposcopy and/or repeat Pap smears; treat if necessary |
- High-Grade SIL |
Large number of abnormal cells in sample |
Perform colposcopy and biopsy; treat if confirmed |
| Squamous cell carcinoma |
Sample contains cells that are probably cancerous |
Perform colposcopy and biopsy; treat if confirmed |
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 UHS Gynecology Clinic
at 734-763-9184.
For more information about HPV, see American Social Health Association
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