Abnormal Pap or HPV Positive: What Happens Next?

This page is for anyone with an abnormal Pap test or a positive HPV test. It explains what the results mean, what follow-up may come next, and how precancer is treated.

Most people who have abnormal cervical screening test results do not have cervical cancer. Most of them either have an HPV infection, or early cell changes that can be watched or treated before they ever become cancer. For people who have been screened at regular intervals, finding cancer on a screening test is very rare.

That is the whole point of cervical screening: it is designed to find changes years before they could turn into cancer, while they are still easy to deal with.

A positive HPV test means high-risk HPV was found, and your health care provider will recommend follow-up steps. A negative result means high-risk HPV was not found, and NCI says the next test would be in 5 years, or sooner if you had abnormal results in the past.

Two things are worth knowing. HPV is common. And CDC says most HPV infections (9 out of 10) go away by themselves within 2 years. A positive test tells you the virus is present now. It does not tell you it will stay, and it does not tell you it has done any damage.

ASC-US — atypical squamous cells of undetermined significance. This is the most common abnormal Pap finding. The cells do not look completely normal, but it is not clear whether the changes are from HPV. An HPV test is usually the next step.

LSIL — low-grade squamous intraepithelial lesions. These are low-grade changes, usually caused by an HPV infection. Your provider will likely recommend more testing.

HSIL — high-grade squamous intraepithelial lesions. These are moderately or severely abnormal cervical cells that could become cancer in the future if they are not treated. Colposcopy is typically recommended.

AGC — atypical glandular cells. These are cells that do not look normal and can be a sign of a more serious problem up inside the uterus. This also leads to colposcopy.

Follow-up is based on your personal risk, which comes from your result, your age, and your past screening history. In practice the plan is usually one of these:

• Return for a repeat HPV test or HPV/Pap cotest in 1 or 3 years.
• Have a colposcopy, usually with a biopsy.
• Have treatment for high-grade cell changes that have already been confirmed.

If a repeat test in a year is recommended, that is not your provider being casual. It reflects how slowly these changes move and how often they resolve by themselves.

Your provider inserts a speculum to gently open the vagina and see the cervix. A vinegar solution is applied to the cervix, which makes abnormal areas easier to see. Your doctor then places an instrument called a colposcope close to the vagina. It is a magnifying device that stays outside your body and lets them look closely at the cervix.

During a colposcopy, a cervical biopsy is usually done — a small sample of tissue is taken from any area that looks abnormal so a pathologist can examine it.

Afterward, some people have bleeding and/or discharge. Others have pain that feels like cramps during menstruation.

Biopsy findings are graded as cervical intraepithelial neoplasia, or CIN.

CIN 1 changes are mild, or low grade. They usually go away on their own and do not require treatment.

CIN 2 changes are moderate and are typically treated by removing the abnormal cells. However, CIN 2 can sometimes go away on its own.

CIN 3 changes are severely abnormal. Although CIN 3 is not cancer, it may become cancer and spread to nearby normal tissue if not treated. Unless you are pregnant, it should be treated right away.

LEEP (loop electrosurgical excision procedure). A thin wire loop, carrying an electrical current, is used to remove the abnormal tissue. Local anesthesia is used. It is done in your provider's office and takes only a few minutes.

Cryotherapy. A special cold probe destroys the abnormal tissue by freezing it. It is done in the office, takes only a few minutes, and usually does not require anesthesia.

Cold knife conization. A scalpel removes a cone-shaped section of abnormal tissue. This is done at the hospital and requires general anesthesia.

Laser therapy. A narrow beam of intense light destroys the abnormal tissue. It is an outpatient procedure that may be done under local or general anesthesia.

If you are pregnant or plan to become pregnant and are found to have high-grade cervical cell changes, your health care provider will talk with you about which treatments are recommended for you and the timing of those procedures. Depending on your specific diagnosis, you may be treated after delivery.

• What exactly did my Pap and HPV results show?
• Based on my result and history, what is my recommended follow-up: repeat testing, or colposcopy?
• If it is repeat testing, is that in 1 year or 3 years, and how will I be reminded?
• If I have a biopsy, what CIN grade came back, and does it need treatment?
• Which treatment do you recommend, where is it done, and what should I expect afterward?
• Does anything about this change my plans for pregnancy?

Light bleeding, watery discharge and period-like cramping are expected after a cervical biopsy, LEEP, cryotherapy or a cone procedure. A few things are not, and they should not wait for your next appointment.

• Call 911 or go to an emergency department if you are soaking a pad an hour or more, passing big clots, or feeling faint, grey, or breathless. Bleeding that fast needs to be seen at once, not booked into a clinic slot. Do not drive yourself.
• Call your care team the same day if the bleeding is heavier than your usual period, or if you have belly or pelvic pain, or signs of infection such as a fever, a foul odour, or discharge that has changed.
• Call your care team within a day or two if spotting or discharge goes on longer than your clinic told you to expect, or if you never received the biopsy result you were told to expect.

Nothing on this page replaces the aftercare sheet your own clinic gives you. If it sets different rules, follow theirs.

• National Cancer Institute — HPV and Pap Test Results: Next Steps after an Abnormal Test: https://www.cancer.gov/types/cervical/screening/abnormal-hpv-pap-test-results
• National Cancer Institute — Understanding Cervical Changes: A Health Guide: https://www.cancer.gov/types/cervical/screening/abnormal-hpv-pap-test-results/understanding-cervical-changes.pdf
• MedlinePlus — Colposcopy-directed biopsy: https://medlineplus.gov/ency/article/003913.htm