Understanding your Pap smear test results and HPV

Getting a Pap smear, which takes an average of 10 minutes, is probably not one of your favorite activities. We can think of more fun things to do than getting a speculum put into your vagina. But, unfortunately it's necessary for the gynecologist to view the cervix in the vagina during the examination. Getting the result of the test is also something many women are afraid of. That’s understandable, you’ll never know if you’ll get bad news but you often don’t have to worry. The cells in your cervix - just like your skin -  are constantly dividing. If there’s something wrong during the cell division, such as an inflammation or infection, an abnormality can arise. This abnormality is also called dysplasia. Our body is usually able to clean up these abnormal cells on its own. When your body isn’t able to do this, one can also speak of the preliminary stage of cervical cancer (cervix carcinoma). If the dysplasia continues to increase, there’s a chance you develop cervical cancer. But there’s no reason for panic! The process from the preliminary stage to actual cervical cancer can take ten to fifteen years.

human papillomavirus

The disruption of cell division is caused by the Human papillomavirus in 98% of the cases, commonly referred to as HPV. This virus is spread through sex - both penetration and oral - and usually doesn’t cause any symptoms. Almost 90% of all sexually active women in the Netherlands are infected with this virus. In some cases, the body is unable to clean up the virus. For instance with women who smoke. This is because smoking can lower your resistance, which makes it very difficult for your body to clear the virus. When the virus isn’t cleaned up by your body, you’ll become a carrier. Women who carry the virus are at risk of developing early stage cervical cancer. Therefore it is important to get regular Pap smear tests if you’re a carrier.

Rather not contract HPV? Using a condom reduces the risk of infection by 70%. And yes, this also applies to oral sex! There are flavored condoms for a reason….

Vaccine

HPV is sexually transmitted and once you’re sexually active, almost everyone will experience an HPV infection at some point in their life. You don’t notice this, by the way. The virus doesn’t cause any further symptoms and your body will clear the virus on its own in most cases. Some women continue to carry the virus. Smoking unfortunately plays an important role in this: women who smoke have a more difficult time getting rid of the virus. One more reason not to smoke (anymore)! You can get vaccinated against the HPV virus. It’ll prevent a bad Pap test result, but it is by no means a guarantee. The vaccine is most effective if you don’t have an HPV infection at that time and also when you get it at a young age. That’s why the vaccination is included in the national vaccination program for young girls in the Netherlands. Of course you (or your parents) choose whether you want to get vaccinated or not.

Did you not get vaccinated as a young girl and do you still want this? It’s possible to get vaccinated at a later age, although it is not (yet) fully covered by insurance. The tricky part is that vaccines may be less useful if you have or have had an active HPV infection. Also,  you can’t really know whether you’re currently infected without getting a Pap smear. If you have a good test result, you could consider getting vaccinated after all.

Are you vaccinated against HPV? Then there’s certainly a smaller risk of the HPV virus, but there’s still a chance you’ll get infected. HPV consists of more than 100 types, 12 of which can cause cancer. The vaccine covers two variants, which together are responsible for 70% of all cervical cancer cases. Are you vaccinated against HPV? Then you’ve been vaccinated against HPV 16 and 18 - the big culprits. But there are still 13 other types that are much less aggressive and harmful.

Side note: when you get a positive Pap test result, it doesn’t state which form of HPV it is.

When should you go to your GP?

Anyone can suffer from dysplasia, but from the age of 30 the chance of an abnormal result increases. If you’re walking around with a form of HPV, you can experience certain symptoms, but that doesn’t have to be the case. What’s more, not all women with an abnormal Pap test result have the HPV virus in their blood. There are also other abnormalities that aren’t related to HPV. An irritation of the cervix or a fungal infection can give abnormal results as well. The most common symptoms are:

• Postcoital bleeding, which is bleeding (shortly) after or during sex.

• Intermenstrual bleeding, bleeding between periods.

• Excessive discharge, larger amount and thicker consistency of the discharge.

• Bleeding after menopause, bleeding that occus after not having a period for a year. Please note: this symptom only relates to cervical cancer.

In all these cases we advise you to go to your doctor and discuss your symptoms. Don’t wait for your invitation for the national screening, but go to your GP on your own initiative!

The different PAP results

In the Netherlands, PAP results - from George Papanicolauo, a Greek doctor who classified Pap test results - are indicated with numbers from one to five. The description of the Pap test results contains the so-called KOPAC score. It provides better and more extensive information than the PAP classification. That’s why doctors also work with the KOPAC score in addition to the PAP result.

This is what your PAP result means in the Netherlands:

PAP 0: The Pap smear can’t be properly assessed, there may have been too much blood. In this case, the Pap smear must be performed again.

PAP 1: The Pap smear is good. The cells are normal and you can come back for a check in five years.

PAP 2: Some cells in the cervix are abnormal. In most cases, the body cleans up those cells on its own.

PAP 3a: Cells with light or moderate abnormalities were found.

PAP 3b: The cells deviate slightly more than with a PAP 3a result.

PAP 4: The deviation of the cells is even stronger than in 3b. In 90% of the cases, a loop excision is performed.

PAP 5: Highly abnormal cells were found. Further research is necessary, because the result indicates a chance of cervical cancer present. A biopsy is performed.