What Does It Mean If Pap Is Normal, but HPV Is Positive?

What Are Pap and HPV Tests?

What is a Pap Test?

A Pap test, also known as a Pap smear, is a routine procedure used to screen for cervical cancer. During this test, a healthcare provider collects cells from the cervix, which are then examined under a microscope. 

The primary goal of a Pap test is to detect any cellular abnormalities that could indicate precancerous or cancerous changes. These abnormalities, if identified early, can be treated promptly to prevent the development of cervical cancer.

Pap tests detect cellular abnormalities by identifying changes in:

• size
• shape
• organization of cervical cells

This process involves computer-guided screening and review by trained cytotechnologists to ensure accuracy. 

Regular Pap tests are crucial as they help catch any changes early, increasing the chances of successful treatment and maintaining overall cervical health.

What is an HPV Test?

An HPV test is another essential screening tool, often performed alongside a Pap test. It specifically detects the presence of human papillomavirus (HPV) DNA or RNA in cervical cells. HPV is a common virus with many strains, some of which are high-risk and linked to the development of cervical cancer.

There are more than 100 types of HPV, but according to the National Cancer Institute, HPV 16 and HPV 18 are the primary culprits behind the majority of HPV-related cancers.

An HPV test identifies whether these high-risk types are present, allowing healthcare providers to determine the appropriate follow-up steps. 

Updated guidelines from the American Cancer Society recommend beginning cervical cancer screening at age 25 with an HPV test and continuing with HPV testing every 5 years until age 65.

Understanding Your Results

What Does a Normal Pap Test Mean?

A normal Pap test result, also known as a negative result, means that no abnormal cervical cells were found. This indicates that the cells collected from the cervix appear healthy and do not show any signs of precancerous changes or malignancy. For many women, a normal Pap test result is reassuring and suggests that their cervical health is currently stable.

Normal Pap test results are quite common, especially among women who undergo regular screenings. These results mean that you are at a low risk for cervical cancer at the moment. 

However, it is essential to continue regular screenings as recommended by your healthcare provider because cervical cell changes can occur over time. Regular monitoring ensures that any potential issues are detected and addressed promptly, maintaining your long-term health.

What Does a Positive HPV Test Mean?

A positive HPV test result indicates the presence of high-risk HPV types in your cervical cells. This does not mean that you have cervical cancer, but it does mean that you have a higher risk of developing it in the future. 

Implications of a positive HPV test:

• Presence of high-risk HPV types.
• Increased risk of developing cervical cancer.
• Need for follow-up and close monitoring.

High-risk HPV types, such as HPV 16 and HPV 18, are known to cause changes in cervical cells that can eventually lead to cancer if not monitored and managed appropriately.

When you receive a positive HPV test result, your healthcare provider will recommend follow-up steps based on your specific situation. These steps may include repeat testing, additional screenings, or close monitoring of your cervical health. 

High-risk HPV infections are quite common and often clear on their own within a couple of years. However, persistent infections require careful management to prevent the development of cervical cancer.

How to Read Your Results

Reading and understanding your Pap and HPV test results can be challenging. It's important to consult with your healthcare provider, who can explain your results in detail and answer any questions you may have. They will provide personalized advice based on your medical history and current health status.

Additionally, our website offers an online tool Lab Test Interpretation, where you can upload your Pap smear results and receive a detailed explanation of their meaning. It can help you better understand your health and the necessary steps you need to take. However, online tools are not a substitute for professional medical advice, always consult a healthcare provider before taking any action. 

Reasons for Normal Pap Smear but Positive HPV

It's possible to have a normal Pap smear but still test positive for HPV. Here are some reasons why:

1. HPV Infection Without Cell Changes: HPV can be present without causing immediate changes to the cervical cells. A normal Pap smear means no abnormal cell changes were detected, but the HPV test can still be positive.
2. Early Stage of Infection: The infection might be in its early stages. HPV can take years to cause noticeable cell changes, so the Pap smear might still appear normal.
3. Immune Response: Your immune system might control the HPV infection, preventing it from causing abnormal cell changes, resulting in a normal Pap smear despite a positive HPV test.
4. Low-Risk HPV Strains: You might be infected with a low-risk HPV strain, which is less likely to cause significant changes in cervical cells.
5. Transient Infection: HPV infections are often temporary. The virus can be present and then cleared by your immune system without causing long-term changes to cervical cells, resulting in a normal Pap smear.
6. False Negative Pap Tests: Sometimes, Pap smears may not detect existing abnormalities. This can happen due to sampling or interpretation errors, leading to a normal result even when HPV is present. Also, a recent publication in the Lancet highlights that self-collected HPV samples may have lower sensitivity compared to clinician-collected samples, potentially leading to false negatives due to inadequate specimen collection.
7. Focal Abnormalities Not Sampled: Abnormal cells might be present in areas of the cervix that were not sampled during the Pap smear. This can result in a normal Pap test despite the presence of HPV.

Understanding these reasons helps in recognizing that a normal Pap smear alongside a positive HPV test isn't uncommon and doesn't necessarily indicate a severe problem. Regular monitoring and follow-up tests are essential to manage and track any changes.

What Should You Do Next?

If you test positive for HPV but your Pap test is normal, healthcare providers will likely suggest repeating both the Pap and HPV tests in one year. This follow-up is essential to monitor any changes over time and to detect any potential abnormalities early.

Possible Outcomes of the Second HPV Test:

• Negative HPV Test Result: A negative result in the follow-up HPV test indicates that the high-risk HPV infection has likely cleared. In this case, returning to the regular screening schedule is advised. This typically involves Pap and HPV tests every three to five years, depending on age and overall health.
• Positive HPV Test Result: If the follow-up HPV test is still positive, additional examination will be necessary. A colposcopy might be recommended, which involves examining the cervix in detail with a magnifying instrument to spot any abnormal cells that could have been missed in earlier tests.

Regular communication with healthcare providers and following their recommendations for screening and follow-up care are essential components of effective cervical health management.

Long-Term Management and Prevention

Regular Screening Importance

Regular screening is crucial for maintaining cervical health and preventing the progression of HPV-related changes to cervical cancer. The frequency of screenings depends on your age and health history. 

The ACOG recommends the following guidelines for cervical cancer screening:

• Under 21 Years Old: Pap smears are not recommended for women under 21, regardless of sexual activity.
• 21 to 29 Years Old:
  • Have a Pap test alone every three years.
  • HPV testing alone can be considered for women aged 25 to 29, but Pap tests are preferred.
• 30 to 65 Years Old: 
  • Pap test combined with an HPV test (co-testing) every five years.
  • Pap test alone every three years.
  • HPV testing alone every five years

Prevention Strategies

Reducing the risk of HPV infection is key to preventing cervical cancer. Here are some practical tips:

1. HPV Vaccine: The HPV vaccine is highly effective in preventing infections from the most common cancer-causing HPV types, including HPV 16 and HPV 18. It is recommended for preteens aged 11-12 but can be given as early as age 9 and up to age 45.
2. Safe Practices: Using condoms and dental dams during sexual activity can reduce the risk of HPV transmission. Limiting the number of sexual partners and avoiding smoking also contribute to lowering your risk.
3. Regular Check-Ups: Regular visits to your healthcare provider for screenings and discussions about your sexual health can help in early detection and prevention of HPV-related issues.

By implementing these strategies, you can significantly reduce your risk of HPV infection and its potential consequences. Staying informed and proactive about your health is the best way to ensure long-term well-being.