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What causes abnormal pap smears

What Causes Abnormal Pap Smears Besides HPV?

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Pap smears are probably one of the most common diagnostic tests used to ensure female reproductive health. These tests are most commonly used to detect HPV and cervical cancer, but there are other things that can affect your Pap smear results.
If you want to know what causes abnormal Pap smears besides HPV, just keep reading!
Although Pap smears are primarily done for HPV and cervical cancer screening, they can also detect other abnormalities in your reproductive system.
In addition to HPV, other infections can cause inflammation and microscopic changes that can be detected during a Pap smear, causing an abnormal result. According to the University of Michigan , infections that can alter the results of your Pap smear include:
However, it’s important to keep in mind that a Pap smear isn’t the most sensitive test to diagnose these infections or other types of STIs. You could receive a perfectly normal Pap smear result even if you also have symptoms of another STI. If you ever experience symptoms of an STI, it’s important to disclose them to your healthcare provider so they can run the necessary tests and prescribe treatment if needed.
In some cases, STI testing and Pap smears can be carried out during the same cervical exam. According to the Cleveland Clinic , this means that your healthcare provider may take a small sample of vaginal fluid to test for STIs, in addition to the sample of cervical cells used for the Pap test.
If you receive an abnormal Pap result that could be linked to an infection besides HPV, your physician could recommend repeating the test after the infection has been treated and cleared.
Using certain products the days before your test can make it more difficult to obtain Pap smear results, and they can even obscure the presence of abnormal cervical cells. Engaging in intercourse can also alter these results, since sperm cells could still be present in your sample.
Some of the factors that can affect your Pap smear include:
Papanicolaou or Pap smears were invented by Greek physician Georgios Papanikolaou in the 1920s — hence the name of the test. According to the Mayo Clinic , a Pap smear is performed by collecting a small sample of cells from a woman’s cervix. The cervix is the lower, tubular portion of the uterus which is located at the top of the vagina.
After the sample has been collected, a microscope is used to look for abnormalities in your cervical cells. The main purpose of a Pap smear is to detect precancerous and cancerous changes that can be caused by certain strains of human papillomavirus (HPV) and can potentially lead to cervical cancer . This test is simple, affordable, and effective, which is why it’s widely used for cervical cancer screening around the world.
As long as the sample is collected correctly, Pap smears can detect even small precancerous changes, giving women a greater chance to receive treatment promptly. According to the World Health Organization , cervical cancer is the fourth most common type of cancer affecting women worldwide, and according to a study published by the Annals of Oncology , Pap smears and regular screening can reduce the incidence of cervical cancer by up to 80 percent.
So, we know that Pap smears are incredibly important for HPV and cervical cancer screening, but what can cause abnormal Pap smears besides HPV?
The guidelines that recommend when a woman should start getting Pap smears, and how often they should be performed can vary from one country to the next. In the United States, most physicians recommend getting Pap smears at the age of 21 — but only if you’re sexually active, since HPV is transmitted through intimate and sexual contact. In other countries, screening can start from ages 20 to 25.
According to Johns Hopkins Medicine , women ages 21 to 29 with normal Pap smears should get this test done once every three years — although your OBGYN could still recommend a yearly general checkup. Women over the age of 30 should receive primary HPV testing in addition to their scheduled Pap smear.
As we mentioned above, inadequate preparation can alter the results of your Pap smear. To prepare for this test, you should:
Pap smears are an incredibly helpful tool that helps us screen for HPV and cervical cancer, making it possible to detect even the earliest signs of these diseases. Thanks to Pap smears, many women around the world have been able to receive life-saving treatment. It’s important to get your Pap smears according to schedule, and to prepare for the exam to increase the chances of an accurate result.

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Millions of women get Pap smears or Pap tests every year to screen for cervical cancer . (The cervix is the lower part of the uterus, which leads into the vagina.) This simple procedure is part of a regular visit to a gynecologist. A Pap smear consists of swabbing cells off of your cervix and sending them to a lab where a specialist looks at them under a microscope to determine if they look normal or abnormal.

Pap tests can be a bit uncomfortable and sometimes a little awkward. Still, most Pap test results come back normal. However, some 2% to 5% of people who have a Pap test—named after the originator of the exam, George Papanicolaou—will have an abnormal result, Adi Davidov, MD , director of gynecology and robotic surgery at Staten Island University Hospital, told Health.

If you're one of those individuals, you're probably more than a little nervous about what "abnormal" really means. Here's what you need to know.

For starters, abnormal cells on Pap test results do not necessarily mean you have cancer. "There can be many different reasons why a Pap smear may be abnormal," Nazia Munir, MD , a family physician at Henry Ford Health System in Detroit, told Health. "The most common is the human papillomavirus ."

HPV is responsible for almost all cases of cervical cancer. But testing positive for the virus does not mean you actually have cancer. Around 90% of the time, the virus, which is sexually transmitted, clears on its own, leaving no evidence in its wake. "A lot of times patients have HPV and are completely asymptomatic," said Dr. Munir. Some may have mild symptoms but still recover completely.

When HPV does lead to pre-cancerous or cancerous changes in cervical cells, those abnormally growing cells will be categorized as mild, moderate, or severe, Leslie McCloskey, MD , associate professor of obstetrics, gynecology, and women's health at Saint Louis University, told Health . If this happens, your health care provider will help you determine the best course of treatment.

Certain vaginal infections can be a potential cause of abnormal Pap smears. In a 2021 study published in the Europasian Journal of Medical Sciences , 14.39% of patients with abnormal smears experienced cervical-vaginal infections.

A July 2020 study in the Indian Journal of Sexually Transmitted Diseases and AIDS , researchers found that 96% of the Pap smears in 50 patients were abnormal and included indications of sexually transmitted infections (STIs) such as chlamydia, gonorrhea, and trichomoniasis, among other issues.

Yeast infections , medically known as candidiasis, can also cause changes in cervical cells, resulting in an abnormal result on your Pap smear. Fortunately, all of these infections can be treated.

In rare instances, even inflammation–perhaps from having sex recently–can lead to an abnormal Pap test result. Additionally, menopause can produce changes in cervical cells because of dwindling estrogen levels. "When there's not that much estrogen, cells can look funny and mimic precancerous conditions," said Dr. Davidov.

If your Pap results come back abnormal, your health are provider will want to follow up to find out what, if anything, is going on.

If you haven't had one already, your provider may order a second test that looks for HPV DNA. This will tell you if HPV is a likely cause of the abnormal results. It can even tell you if you have one of the specific strains (often HPV 16 or 18) that cause cervical cancer, though it won't say if you have the disease.

The next step is a colposcopy. According to Medline Plus , a colposcopy is when a provider looks closely at the cervix with a microscope-like device called a colposcope. A diluted vinegar solution is often applied to the cervix to temporarily change the color of any abnormal areas, making them easier for your health care provider to see.

Not every abnormal Pap test warrants a colposcopy, especially in younger women, said Dr. McCloskey. "Their risk of having [cervical cancer] is so low, on occasion we may just elect to repeat a Pap test in six months or a year"—to see if the results are still abnormal.

If anything looks more than mildly wrong in a colposcopy, health care providers will do a biopsy, which is the removal of a small sample of tissue or cells to test further in the lab, according to MedlinePlus ,. A biopsy will tell you specifically if you have cancer or precancerous changes. "If the biopsy result confirms that there is a precancerous condition, the patient usually requires treatment that removes the precancerous condition," said Dr. Davidov.

In general, women under 30 should get a Pap test every three years starting at age 21. From 30 on, women should get a Pap plus an HPV test every five years. That remains true whether or not you've been vaccinated against HPV. The vaccines don't protect against all strains of HPV. If you happen to be pregnant when it's time for your Pap smear, the test can still be done as usual. Health care providers can even follow up on abnormal Pap results with a colposcopy, if needed.

A Pap test can tell you something might be wrong—but it can't tell you what the problem is. According to the Centers for Disease Control and Prevention (CDC) , every year, nearly 12,000 women are diagnosed with cervical cancer and around 4,000 die from the disease. But most are preventable, said Dr. McCloskey, "if patients come for Paps and for the appropriate follow-up."

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