According to the Centers for Disease Control and Prevention (CDC), the human papillomavirus is a common virus that is transmitted through sexual activity. In fact, HPV infection is the most common sexually transmitted infection (STI).
In many cases, an HPV infection can go away on its own. In fact, about 90 percent of HPV cases clear up on their own in one to two years. There’s a strong link between HPV and Pap smear abnormalities: Almost 70 percent of abnormal Pap smears are caused by HPV.
There are many types of HPV. Some types of HPV can cause health problems, like genital warts, whereas other types can cause several cancers, including cervical cancer. HPV can cause cancer even if it doesn’t show any symptoms.
“Sometimes we need to understand what type of HPV is present to understand the next steps,” explains Aparna Sridhar, MD, associate clinical professor of obstetrics and gynecology at the David Geffen School of Medicine in Los Angeles.
HPV infection can affect anyone who’s sexually active, and generally it doesn’t show any signs or symptoms. This is why, if you’re diagnosed with the virus, it is important to discuss it with your sexual partner.
There’s no treatment for the virus in itself, but there are treatments for the problems it causes. For example, if the biopsy reveals precancerous cells in your cervix, there are several options to remove them. In the case of genital warts, your healthcare provider will prescribe medication or a surgical ablation procedure to get rid of them. Your healthcare provider will explain your options to you, depending on your situation.
The HPV vaccine protects against genital warts and most cases of cervical cancer. It is recommended for teens and young adults between ages 15 and 26. Although less beneficial, the HPV vaccine might be recommended for some adults between ages 27 and 45 who were not already vaccinated.
The HPV vaccine may also be given to help with treatment for moderate or severe CIN.
2. Cervical Dysplasia (CIN)
Cervical dysplasia is not cancer but an abnormality in the cells which, if left untreated, can lead to cervical cancer.
Cervical dysplasia is also called cervical intraepithelial neoplasia (CIN). There are many stages of cervical dysplasia. If you have mild or low-grade dysplasia, your healthcare provider may simply choose to monitor you for the time being with follow-up exams until any further changes occur. “Early detection is key for identifying precancerous cells in the cervix and offering treatment or more surveillance,” Dr. Sridhar adds.
For more advanced stages of dysplasia, your doctor will likely recommend removing the cells. There are several ways to do so, including:
Cryotherapy A technique that kills the abnormal cells by freezing them
Minimally Invasive Surgery A procedure to cut and remove the cancerous tissue
3. Cervical Cancer
According to the National Cancer Institute (NCI), cervical cancer is “cancer that starts in the cells of the cervix,” which is the lower end of the uterus.
Cervical cancer doesn’t tend to cause any symptoms until it gets to more advanced stages, which is why screening is so important. And according to the World Health Organization (WHO), you should see your doctor if you experience any of the following:
Unusual bleeding (which includes bleeding between periods, after menopause, or after you’ve had sex)
Abnormal vaginal discharge or vaginal discomfort
Pain that won’t go away in the back, legs, or pelvic area
Weight loss, fatigue, or loss of appetite
Swelling in the legs
Cervical cancer is a slow-growing cancer. It can take years, or sometimes even decades, to develop. This is why, as long as you have routine exams, your healthcare provider can detect abnormal or precancerous cells early enough to remove them before they develop into cancer.
If you do get diagnosed with cervical cancer, remember that there are many treatment options available, ranging from minimally invasive surgery and immunotherapy (like for cervical dysplasia), to radiation therapy and chemotherapy.
4. Trichomoniasis and Other STIs
Pap smear abnormalities can also be caused by trichomoniasis, an STI caused by the parasite Trichomonas vaginalis. In women, trichomoniasis causes symptoms such as:
If you’re experiencing any of these symptoms, your doctor will likely take a sample of your vaginal fluid and examine it under a microscope. This is called a wet prep microscopy.
If you have trichomoniasis, you will need to take antibiotics as part of your treatment. This STI affects all sexes, but it usually doesn’t cause any symptoms in men. So, be sure to discuss your results with your sexual partner, as they will need treatment as well.
5. Vaginal Infection
An abnormal Pap test result can also indicate that you have a vaginal infection. But a vaginal infection doesn’t necessarily mean an STI. For example, you may have an infection from bacteria (like in the case of bacterial vaginosis) or a fungus (like Candidiasis).
Vaginal itching
Foul-smelling discharge
Pelvic pain
Bleeding between periods
Your doctor will recommend a form of treatment depending on the type of infection that you have. For example, if your infection is bacterial, you will have to take an antibiotic, but if it’s fungal, an antifungal treatment is most likely.
Your doctor may also perform a follow-up screening test to rule out any additional problems.
6. Harmless Abnormal Pap Smear Causes
There are many harmless reasons a Pap smear result can come back abnormal. If you’ve recently had sexual intercourse, this can affect the cells of the cervix. Having recently menstruated or being close to the start of your period can also cause cervical changes. Using tampons can affect the results, too. It’s best to avoid these things before a Pap smear.
Most often, Sridhar says, “false results are due to lab errors.” According to the American Cancer Society, you can do a few things to make sure your Pap test is as accurate as possible:
Schedule your test at least five days after your menstrual period has stopped.
Limit the use of tampons, spermicide gels, lubricants, or other vaginal creams or moisturizers for up to seven days before your test.
Avoid vaginal sex in the 48 hours leading up to your test.
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