Brenda Spriggs, MD, MPH, MBA
Pap smears are often performed as part of a routine gynecological examination. This screening test allows gynecologists to detect abnormal cells that can be indicative of cervical cancer or cervical dysplasia, which is a precancerous condition. Although most cases of cervical dysplasia are caused by an HPV infection, it is possible for patients to have an abnormal Pap smear in the absence of any detectable HPV strains.
An abnormal Pap smear, according to the American Congress of Obstetricians and Gynecologists, can come in many forms. Atypical squamous cells of undetermined significance, also known as ASC-US, indicate that there are abnormal cells in the cervix, but their cause is not known. This is the most common abnormal Pap smear result. While this is most commonly caused by an HPV infection, it does not mean that the patient is at high risk for cervical cancer or that she necessarily has an HPV infection. Other abnormal results not caused by HPV, according to Family Doctor, include inflammation and hyperkeratosis or dried skin cells.
A number of non-HPV causes exist for an abnormal Pap smear, American Pregnancy explains. Recent sexual activity can lead to abnormal cells appearing on the Pap smear. Other causes include a sexually transmitted infection, inflammation of the vagina and herpes. According to Family Doctor, use of a cervical cap or diaphragm can also result in an abnormal Pap smear.
In most situations, an abnormal Pap smear will be cause for a patient to receive an HPV test, American Pregnancy explains. This test looks for DNA that is part of HPV. If the test comes back negative, it means that the patient is not currently infected with HPV. Women with abnormal Pap smear results should receive another Pap smear within three to six months, regardless of their HPV status. This allows the patient's physician to see if the initial abnormal Pap smear was an isolated finding or if there is some other gynecological problem occurring. Patients with inflammation, for example, could have a vaginal infection which should be treated with antibiotics. A repeat Pap smear allows the physician to determine if the problem is resolving itself.
If the second Pap smear is also abnormal, other testing may be necessary, Family Doctor explains. The patient's doctor may choose to perform a colposcopy, which is a procedure in which the doctor examines the cervix with a device similar to a microscope called a colposcope. Some physicians will coat the patient's cervix with a vinegar solution beforehand, which will turn any abnormal areas white. This allows the gynecologist to get a better view of any cervical abnormalities and can allow for a more accurate diagnosis.
Cervical dysplasia, even in the absence of a detectable HPV infection may require further treatment. One common treatment, according to American Pregnancy, is cryosurgery, in which the abnormal cells are frozen. A cone biopsy can also be performed to eliminate the abnormal cervical tissue. Another procedure, called LEEP, uses a small loop with an electrical current to burn away potentially dangerous cervical tissue.