Abnormal Pap Test: What It Means and What to Do Next

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Abnormal Pap Test: Causes, Diagnosis, and Treatment


A Pap test, also known as a Pap smear, is a screening procedure for cervical cancer that examines cells collected from the cervix. An abnormal Pap test indicates the presence of abnormal cells, which could be precancerous or cancerous. Understanding the causes, diagnosis, and treatment options for an abnormal Pap test is crucial for women’s health.

Causes of Abnormal Pap Tests:

  • Human papillomavirus (HPV): HPV is the most common cause of abnormal Pap tests. It is a sexually transmitted infection that can cause warts or precancerous cervical cell changes.
  • Other infections: Chlamydia, gonorrhea, and herpes simplex virus can also cause cervical cell changes.
  • Hormonal changes: Excess estrogen can promote abnormal cell growth.
  • Smoking: Smoking weakens the immune system, increasing the risk of HPV infection and abnormal Pap tests.
  • Weakened immune system: Conditions like HIV/AIDS can weaken the immune system, making women more susceptible to HPV and cervical cell abnormalities.

Grading of Abnormal Pap Tests:

The Bethesda System is used to report Pap test results. Abnormal Pap tests are classified as:

  • Ascus: Cells with uncertain significance; further testing is recommended.
  • Low-grade squamous intraepithelial lesion (LSIL): Mildly abnormal cells; typically caused by HPV and usually resolve spontaneously.
  • High-grade squamous intraepithelial lesion (HSIL): More severe abnormal cells that require further evaluation and treatment.
  • Carcinoma in situ (CIS): Precancerous cells; immediate treatment is necessary.
  • Cancer: The presence of cancerous cells.


An abnormal Pap test result requires further testing to determine the extent and severity of the abnormality. Tests may include:

  • Colposcopy: A magnified examination of the cervix to identify abnormal areas.
  • Biopsy: Removal and examination of a small sample of cervical tissue.
  • HPV testing: Detects the presence of HPV and its specific strains.


The treatment for an abnormal Pap test depends on the grade of abnormality and the presence of underlying HPV infection.

  • Surveillance: Ascus and LSIL often resolve spontaneously with regular monitoring.
  • Cryotherapy: Liquid nitrogen is used to freeze and destroy abnormal cells.
  • Excisional procedures: Loop electrosurgical excision procedure (LEEP) or cold knife conization are used to remove abnormal tissue from the cervix.
  • Laser surgery: A laser is used to vaporize abnormal cells.
  • HPV vaccination: For women who are not yet infected with HPV, vaccination can protect against future infections.


After treatment, regular follow-up appointments are essential to monitor for any recurrence of abnormal cells. The frequency of follow-up varies depending on the severity of the abnormality and the treatment provided.


  • HPV vaccination: HPV vaccination is the most effective way to prevent cervical cancer. It should be given to all girls and boys ages 11-12.
  • Condom use: Condoms can reduce the risk of HPV transmission during sexual activity.
  • Regular Pap tests: Women should have regular Pap tests starting at age 21.
  • Smoking cessation: Quitting smoking can improve the immune system and reduce the risk of HPV infection and abnormal Pap tests.
  • Healthy lifestyle: A healthy diet, exercise, and maintaining a healthy weight can support the immune system and reduce the risk of cervical cancer.


Abnormal Pap tests can be a sign of underlying cervical cell changes that may lead to cervical cancer. Understanding the causes, diagnosis, and treatment options is important for women to make informed decisions regarding their health. Early detection and appropriate treatment of abnormal Pap tests can significantly reduce the risk of cervical cancer and improve overall health outcomes. Regular Pap tests and HPV vaccination play a crucial role in preventing cervical cancer and ensuring women’s well-being throughout their lives.

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