PAP & HPV Testing Guidelines
Have you been wondering about how often you need to have a pelvic exam? Or pap smear?
Over the last decade or so, there have been recommendation changes that are confusing. It was simple when it was recommended that a pap was done yearly. And in fact, many people called their annual exam, their “pap”. But that’s no longer true.
The technology has evolved and the old days of clumping cells onto a slide are over. Now, when a pap is done, the sample is taken with 1 or 2 brushes and placed in a special vial of liquid. This allows the individual cells to float more freely and not get overlapped and clumped as they did on the old slide. And not only that, we are able to collect and analyze thousands of cells in this sort of sample.
This huge number of cells viewed makes your pap test so much more accurate.
None the less, not all cells can be sampled, so if there is something brewing beyond the reach of the usual cervical area or higher up in the cervical canal where the brushes do not reach, abnormalities could be missed.
For this reason, we do pap testing every 3-5 years, depending on your age and risk.
Testing for HPV
We have a DNA probe that looks for HPV (human papilloma virus). If a high risk type of this virus does happen to be alive and well, and replicating, it is possible that your pap is a false negative. It is a very useful tool if your pap shows atypical cells (often called ASCUS or Atypical Cells of Undetermined Significance).
If you see this on a pap, do not worry, many things can cause cells to be atypical: generalized inflammation (very common due to the many organisms that reside there!), a yeast or bacterial infection, pregnancy changes, menopausal changes, etc. So, the HPV test in this setting is very helpful, because if it is negative, then we assume that ASCUS is not associated with a precancerous change. If it is positive, however, we want to take a closer look to be sure that the ASCUS do not actually represent precancerous changes, as we know that the virus has potential to turn on cell growth that over time can turn into cervical cancer.
How common is HPV?
For women under age 30, it is so common to see HPV, that is not a valuable test. Over age 30, one should have developed immunity to any previous exposures and/or it has completely resolved.
Some HPV does actually hide in the cells in a dormant state and may never be heard from again, so even if you have tested negative (or positive) in the past, retesting is still important. It can also come out of dormancy at times of stress or illness, so again routine screening on schedule is important.
Over age 30, we do the “co test” (which is both pap and HPV test) or sometimes just the HPV test.
Current screening recommendations
Age 21-29: pap every 3 years
Age 30-65: co test or HPV test alone every 3-5 years.
If you have had an abnormal, the schedule is more individualized, but is usually yearly until the HPV infection has resolved.
The HPV vaccine
Having the HPV vaccination (now available from adolescence to age 46) is a great method to reduce the risk of infection from 9 of the highest risk types, but cannot protect you from all HPV, so even with vaccination, the pap/HPV test schedule is the same.
The vaccine is such an important option as it markedly reduces your risk of cervical, vaginal, vulvar, anal and oral cancers and can help to keep any suppressed virus in the dormant phase.
When to get an annual exam
We still recommend an annual exam to go over preventative measures as well as follow up on any new or old medical problems, review and renew medications, assess your wellness and discuss any important health issues that you have.
Being able to touch base with a provider annually is the best way to keep up your good health.
So while, we don’t do “the pap” annually, we DO recommend that you come in for your “annual exam”.
Contact us to request an appointment today!
