Abnormal Pap Smear but Negative HPV: What It Means
Quick answer
A Pap test can show abnormal or unclear cells even when the HPV test is negative. The CDC says unclear results are common and can be linked to life changes such as pregnancy, menopause or an infection, not only to HPV. For a mild result such as ASC-US, MedlinePlus says repeat Pap or HPV testing is recommended, with colposcopy if an HPV test is positive. More serious Pap results still need a colposcopy. Follow the plan your clinician gives you.
Getting a letter that says your Pap smear was abnormal, then learning the HPV test was negative, is confusing. If HPV is the usual cause of cell changes, where did the changes come from? The answer is usually less worrying than it sounds.
What does an abnormal Pap smear with a negative HPV test mean?
Two different tests are involved. The CDC explains that the Pap test looks for precancers, cell changes on the cervix that might become cancer if they are not treated. The HPV test looks for the virus that can cause those changes.
A negative HPV test means you do not have an HPV type linked to cervical cancer. An abnormal Pap alongside it means some cells looked unusual under the microscope, but not necessarily because of HPV. Some abnormal results are minor, and the CDC says that most of the time, minor changes go back to normal on their own.
What does ASC-US mean if my HPV test is negative?
ASC-US is one of the most common abnormal Pap results, according to MedlinePlus. The CDC says it may also be called equivocal or inconclusive, and that it means your cervical cells look like they could be abnormal. It is common for results to come back like this.
The CDC adds that it isn’t clear whether the change is related to HPV, and that it could be related to life changes like pregnancy, menopause or an infection. MedlinePlus lists HPV infection, inflammation and low estrogen, as happens in menopause, as causes. It describes ASC-US as a mild change, and says repeat Pap testing or HPV testing is recommended, with colposcopy if an HPV test is positive.
That is why the HPV test is used as a second step. A negative result means no high-risk HPV type was found in your sample. Your clinician will still decide how and when to re-check.
Does a negative HPV test mean I can ignore other abnormal results?
No, it depends on how abnormal the Pap result was. MedlinePlus describes the most common results and the usual response:
- ASC-US (mild change): repeat Pap or HPV testing; colposcopy if HPV is positive.
- LSIL (mild change): colposcopy is recommended unless the HPV test is negative, in which case repeat Pap or HPV testing in one year is often recommended.
- ASC-H, HSIL or atypical glandular cells (more serious changes): colposcopy is recommended.
So a negative HPV test can change the plan for mild results, but it doesn’t remove the need for follow-up on higher-grade ones. Ask your clinician exactly which result you had.
Why would I need a colposcopy if my HPV test was negative?
A colposcopy lets a clinician look closely at your cervix with a lighted, magnifying device. It is recommended for the more serious Pap results regardless of the HPV result, because those changes can be a sign of precancer or, rarely, cancer, according to MedlinePlus. The CDC says in rare cases an abnormal Pap can show that you may have cancer, which is why other tests are used to be sure.
The CDC also says that if your results show cells that may become cancer, your doctor will tell you whether you need treatment, and in most cases treatment prevents cervical cancer from developing.
Could the test have been wrong?
It’s possible. MedlinePlus says the Pap test is not 100% accurate, which is why repeat testing is recommended over time. A sample can also be unsatisfactory, for example when there aren’t enough cells, and then you may be asked to come back for another test in a few months.
If your result doesn’t match what you expected, ask your clinician to talk you through it rather than trying to settle it alone.
What should I do next?
- Book the follow-up your clinician recommended and keep the date.
- Ask for the exact name of your Pap result and the plan in writing, if possible.
- For future Pap tests, the CDC advises avoiding sex, douching and vaginal medicines or spermicidal foam for two days beforehand.
- Remember that cervical precancer usually causes no pain or other symptoms, so follow-up is how it’s found.
If you were also told you had a positive result, see our guide to what a positive HPV test means.
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- Heavy or unusual vaginal bleeding, or bleeding after sex
- Severe pelvic pain, or pain with a fever
- You were told you need a colposcopy and haven't been able to book it. Call your clinician's office instead of waiting
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When to test
- When you get the resultAsk which Pap result you had (for example ASC-US, LSIL or HSIL), whether the HPV test was negative, and what follow-up is recommended.
- At the follow-up your clinician setsFor a mild result with a negative HPV test, this is often a repeat Pap test or HPV test, sometimes after a year. For more serious results, colposcopy is recommended.
- If your sample was 'unsatisfactory'There weren't enough cells or they were clumped together. Your clinician may ask you to come back for another Pap test in a few months.
Common questions
What does ASC-US with a negative HPV test mean?
ASC-US stands for atypical squamous cells of undetermined significance. It is considered a mild change, and the CDC says it isn't clear whether it is related to HPV. A negative HPV test means no high-risk type was found, so your clinician will decide on repeat testing.
Can an abnormal Pap be caused by something other than HPV?
Yes. MedlinePlus lists HPV infection, inflammation, or lack of estrogen (as in menopause) as possible causes of ASC-US. The CDC adds pregnancy and infection as possible reasons for an unclear result.
Is a Pap test always accurate?
No. MedlinePlus says the Pap test is not 100% accurate, which is why repeat testing over time is recommended. Cervical cancer develops very slowly, so repeat tests usually find changes in time to treat them.
Does an abnormal Pap mean I have cancer?
Usually not. The CDC says an abnormal result usually doesn't mean cancer, and that most minor changes go back to normal on their own. More serious changes can turn into cancer if they aren't removed, which is why follow-up is important.
Sources
This guide is general information written by a patient advocate using public health sources. It is not a diagnosis. Only a clinician who examines you, or a lab test, can tell you what you have. Read how we write and check our guides.