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Common questions about HPV and Pap smear results

In most cases women are surprised and dismayed when their Pap test returns as anything other than normal, and questions abound. Here are just a few of the most common concerns women have regarding HPV and abnormal Pap smear results.

A woman on a video call with her doctor scheduling her pap test

“My practitioner found an abnormal Pap, positive for ‘high-risk HPV,’ and this has me very worried. She sent me to another doctor for a colposcopy, but nothing was found, then he sent me back to the nurse practitioner for follow-up Pap smears. Now what?”

This series of events sound appropriate. Not all clinicians are skilled in colposcopy, so sometimes you have to be sent to a specialist for an advanced testing procedure. The colposcopy findings are reassuring, however — in your case, either the Pap smear was a bit of a false alarm (which is not uncommon), or your body is doing a good job of taking care of the HPV virus you’ve been exposed to. It is important for you to continue the follow-up process as directed by your healthcare practitioners, to verify that the cellular changes remain resolved over time. Nutrition and self-care measures to shore up your immune system are likewise important, as discussed in our article, to promote continued healing.

“I’ve had genital warts and was told they were caused by HPV, so does this mean I will get cervical cancer? I have never had an abnormal Pap test.”

The strains of HPV associated with genital warts are not generally or exclusively high-risk strains associated with cervical cancer. However, a practitioner cannot know for certain how many strains of the virus you have possibly been exposed to, nor the strains to which you may be exposed in the future. So good health and prevention is key. Some research supports the premise that an effective immune response is triggered by using the topical wart treatment known as Aldara (imiquimod). This may be one of the most ideal treatment measures we currently have for warts, and it may also confer an element of protection from the high-risk HPV strains.

“How did I get the HPV virus and an abnormal Pap test? — I practice safe sex with condom use every time!”

HPV virus can be harbored anywhere within the genital region, and condoms cover only a portion of the penis. So in most cases, there is extensive genital contact beyond the condom, allowing the virus to be transmitted very easily. Safe sex is still important to prevent transmission of other STD’s, but an open and honest discussion regarding both party’s sexual history and the topic of STD’s prior to having sex is a very wise measure.

“My Pap was ‘normal,’ but it also said ‘HPV is detected,’ and to make a follow-up appointment in six months. Is that at all possible? All the information I’ve researched would have it seem that an abnormal Pap is significant if HPV is detected. My ob/gyn also told me that my husband and I can ‘resume our normal lives.’ This is puzzling, because wouldn’t that mean that we were playing ‘ping pong’ with the virus and compromising our immune systems if the virus is even present?”

The result you received is a very common finding you may be tested using newly available viral technology to detect the HPV virus itself, separate from evaluating the health or quality of the tissue cells sampled. So even if no abnormality in the cells is seen on the sample, the virus can be detected.

Different practitioners may follow slightly different follow-up algorithms with this finding, depending on whether they adhere to guidelines developed by the American College of Obstetricians and Gynecologists (ACOG), the American Society for Colposcopy and Cervical Pathology (ASCCP), or Planned Parenthood.

But in most cases this virus will clear, and your practitioner will just want to watch you a little more closely than usual, generally by retesting in six months. This is to ensure that the cervical cells indeed stay normal and that the virus hopefully becomes dormant — which means it becomes undetectable, due to the response of your healthy immune system.

Last Updated: January 19, 2022
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