Pap smear and HPV testing: what you need to know

Table of Contents

• How does a Pap smear work?
• How does an HPV test work?
• Which test is best for detecting cervical cancer?
• How often should you get a Pap smear?
• Are there alternatives to a Pap smear?
• How often should you get an HPV test?
• What happens if my HPV test is positive?
• What happens if my Pap smear is abnormal?
• At-home HPV tests

How does a Pap smear work?

Pap smears are the most common method for early detection of cervical cancer and have been used for decades. During a Pap smear, a cell sample is taken from the cervix and examined for changes that could develop into cancer. This sample is collected during a pelvic exam at a doctor’s office. Pap smears do not detect HPV itself but instead identify cellular changes in the cervix.

How does an HPV test work?

In contrast to a Pap smear, HPV tests detect infections of the cervix with HPV and not cellular changes or cancer (NIH, 2022). These tests check for high-risk forms of HPV associated with cancer and not for other low-risk HPV types that cause genital warts. HPV tests can be performed during a pelvic exam, often together with a Pap smear. However, it is also possible to carry out an HPV test outside of a pelvic examination by taking a vaginal swab and submitting the sample for analysis. This swab test can be performed both in a doctor’s office and at home. The HPV test for women from Homed-IQ is a self-swab test that can be done at home. This testing method is also used by some governments for individuals who feel uncomfortable undergoing a swab test performed by a physician. However, if HPV is detected with this test, an additional Pap smear performed by a doctor is always required (RIVM, 2022).

Which test is best for detecting cervical cancer?

While HPV tests can detect infections with cancer-causing HPV types, they do not identify precancerous or cancerous changes of the cervix. For this reason, a Pap smear should be performed for all positive high-risk HPV tests. However, new research suggests that HPV tests may be superior to Pap smears alone in preventing cervical cancer because they detect the cause of cell changes (HPV) before those changes occur (Gage et al., 2014).  Moreover, HPV test results are easier to interpret as either positive or negative, while Pap smears require a visual inspection of the cells by a pathologist—a process that is more prone to error. Further research is needed in this area to determine which screening method is most effective in preventing cervical cancer.

In recent years, high-risk HPV screening has replaced the Pap smear as the first-line screening method for cervical cancer in the Netherlands (Radboud UMC, 2020). According to current guidelines, if a high-risk HPV test is positive, the same cervical sample is examined for cell changes, or in the case of a self-test, a Pap smear is scheduled.

How often should you get a Pap smear?

The starting age and frequency of cervical cancer screening depend on the guidelines of the country you live in. In the Netherlands, screening starts at age 30 and is conducted every 5 years (RIVM, 2022). In Germany, Pap smears are offered annually from age 20. Women over 35 are offered HPV tests and a Pap smear every 3 years (Robert-Koch-Institut, 2022). Screening guidelines often vary by country due to different research findings on the advantages and disadvantages of screening. Although more frequent tests and starting at a younger age can detect more cases of cervical cancer, this can also lead to unnecessary treatments and stress for individuals, since many HPV infections or cell changes do not lead to cancer, and most high-risk HPV infections in young people clear up on their own without treatment (Radboud UMC, 2022). However, some individuals may need to be screened more often or earlier depending on personal factors or the results of previous HPV tests/Pap smears. Talk to your doctor about what is appropriate for you, and don’t hesitate to seek care if you experience symptoms outside of the age group covered by the screening. If you choose an at-home HPV self-test, be sure to read the section “Who is this test suitable for” before making a decision.

Are there alternatives to a Pap smear?

Some women feel uncomfortable getting a Pap smear in a doctor’s office for various reasons. While a Pap smear is necessary to confirm cellular changes in the cervix, screening for high-risk HPV before a Pap test can give women the opportunity to avoid the invasive Pap test if they test negative for high-risk HPV. While many high-risk HPV tests are also performed by physicians, it is also possible to conduct a self-test. Self-tests allow women who do not have access to conventional screening methods to receive care and potentially achieve better health outcomes than if they avoided screening altogether. Possible future HPV screening methods that are not yet approved include urine and menstrual blood tests.

How often should you get an HPV test?

As with Pap smears, the frequency of HPV tests depends on the guidelines of the country you live in. While HPV testing has become the primary method for cervical cancer screening in the Netherlands, it is only used for certain groups in Germany. If HPV tests are not available to you as part of national screening programs, you might consider an at-home HPV test such as the one offered by Homed-IQ.

What happens if my HPV test is positive?

If your HPV test is positive for high-risk HPV, a Pap smear is necessary to examine the cervix for cellular changes. If you took this test during a pelvic exam, the sample can automatically be tested for high-risk HPV if it is positive. If you conducted a self-test at home, you will need to schedule an appointment for a Pap smear with your doctor. A positive HPV test does not mean that you have cancer. However, it is important to see your doctor to ensure that cancer can be ruled out or that further treatment can be initiated.

Tip: Also read our article “Understanding HPV and Cancer.”

What happens if my Pap smear is abnormal?

If your smear shows abnormal cells, your general practitioner will likely refer you to a gynecologist for further treatment. Again, this does not mean you have cancer, but further examinations are needed. Next steps may include more frequent follow-up smears or a colposcopy—a procedure similar to a Pap smear in which a doctor examines the cervix with a magnifying lens and, in some cases, takes a tissue sample for further testing (Johns Hopkins Medicine, 2022).

At-home HPV tests

HPV tests and Pap smears are valuable tools for detecting cervical cancer before it occurs or at an early stage, helping to improve the prognosis or even prevent it altogether. With Homed-IQ, you can conveniently and privately monitor your cervical health from home, whenever you like. This HPV test screens for the two highest-risk HPV types (types 16 and 18) as well as 12 other high-risk types. Simply collect a sample at home and send it to one of our certified laboratories for analysis. You will receive a lab report that you can present to your doctor for follow-up if the result is positive.