9 Abnormal Pap Smear Causes You Should Know (especially if HPV Negative)


Many diseases that women suffer from could have been properly managed – if they were detected and diagnosed early with health screening tests that are recommended to undergo regularly.

These medical checks are meant to detect traces or symptoms of serious health issues such as cancer or HPV infections, with a Pap Smear test is one of such screening procedures.

What is Pap Smear Test and Why It’s Done?

A Pap smear, also known as the Papanicolaou test, is a quick and relatively painless test carried out to screen for cancer or precancer symptoms in the cervix. Women are compelled to undergo regular Pap smear tests when they visit the gynecologist.

The process of carrying out a Pap smear test involves getting some of the cells in the patients’ cervix, and examining them under a microscope to see if there are any abnormal cells in the sample. The discovery of abnormal cells is an indication that the patient might be prone to suffering from cervical cancer or precancerous indication of cervical dysplasia.

The recommended next steps after a Pap smear test will depend on the kind of abnormality and other relevant results discovered in the cells diagnosis:

  • Atypical squamous cells of undetermined significance (ASCUS). The features of squamous cells are flat shaped cells which are found in the healthy cervix. Pap smear results that detect ASCUS show irregularities in the features of the squamous cells which do not indicate the presence of precancerous cells.
  • Cells can also be screened for precancerous tendencies by checking for squamous intraepithelial lesions. If the changes are low grade (LSIL), the patient is not in any immediate danger of suffering from cancer. Where high grade (HSIL) changes is observed, the patient is at risk of suffering from cancer within a short period.
  • Atypical glandular cells (AGC): These glandular cells are found at the entrance of the cervix and inside the uterus. Their function is basically to stimulate the production of mucus. When the AGC is observed to have irregular features, more investigation needs to be carried out to detect any precancerous cells.
  • Squamous cell cancer or adenocarcinoma cells: If this is the indicated result from a Pap smear test, there is a high chance that cancer has already started evolving and the patient would be required to undergo more comprehensive assessments at this stage.


Abnormal Pap Smears Results: What does it Mean? HPV Positive?

When Pap screening test results show abnormal, it is understandable that your first immediate reaction is shocked and alarmed, as abnormal Pap smears results may indicate there is abnormal cells or infection known as dysplasia.
Human Papillomavirus (HPV) is the most common cause of abnormal Pap smears. Further evaluation would be required to determine if the HPV strains discovered are high-risk HPV type that have the tendency to cause cancer, or it’s low-risk HPV types that can cause warts.

The distortion of normal cells features in the cervix can occur when high-risk HPV strains find their way into the cervix to work against the skin cells and make them abnormal. This is a medical condition called cervical dysplasia.

The low-risk HPV virus that causes genital warts can cause abnormal results on a Pap smear, says MedlinePlus. If you have these symptoms, you may need a colposcopy or more frequent Pap smears.
Having abnormal Pap smear does not mean you have cancer.

While the common cause of abnormal Pap smear test results is the presence of HPV, this is not an indication that the patient is definitely infected by HPV and has cervical cancer, because there are also patients who have HPV-negative abnormal pap smear test results without any HPV detected.

Dr. Duncan Burkholder discusses abnormal pap smear and HPV in brief video below.


HPV Negative: What can Cause an Abnormal Pap Smears Besides HPV?

According to WebMD, the American Pregnancy Association, Queensland Government, and Medscape – the reasons of abnormal Pap smear results that are not caused by HPV may include:

  1. Trichomonas / Trichomoniasis that could cause minor changes on atypical squamous cells.
  2. Micro-organism like Candida Albicans, also commonly known as thrush.
  3. Gardnerella which is responsible for bacterial vaginosis.
  4. Actinomyces, an infection on women who use cervical cap or IUD for birth control.
  5. Herpes.
  6. Recent sexual activity.
  7. Common infections or similarly inflammation due to bacteria, yeast or protozoa.
  8. Normal change witnessed in cells due to menopause.


Further Diagnosis of Abnormal Pap Smear Causes

As revealed by OncoLink, when the results of a Pap smear tests indicate the presence of atypical squamous cells of undetermined significance (ASCUS):

  • the patient is usually advised to come back for a repeat test after 6 months and if the results is the same, continue with further investigations using Colposcopy.
  • skin cells in cervix can be screened for high-risk HPV by conducting HPV DNA / blood tests.
  • in cases where the results of ASCUS and the HPV tests turn out negative, the patient would be advised to repeat these tests in within 6 to 12 months.
  • Tests that turn out positive results for ASCUS and HPV will require Colposcopy.

HPV test is reported as either HPV positive or HPV negative:

  • HPV Positive: This is an indication that high-risk HPV strains have been detected in the patients’ cervix which could potentially lead to cervical cancer.
  • HPV Negative: This is an indication that no traces of the HPV virus strain were found in the patients’ cervix.

By conducting the tests above, the physicians will have more convincing evidence to back up the Pap smear tests. They would also know if the patient is being affected by other gynecological issues.

The standard process before the commencement of treatment is to carry out a Colposcopy, a typical biopsy with comprehensive study of tissue samples from the patients’ cervix with a microscope.

The results of the Colposcopy will determine the treatment process that should be started. At this stage, the level of abnormality of the cells would have been ascertained.

Abnormal Pap Smear Treatment Options: What’s Next?

Treatment processes aim at eliminating the abnormal cells:

  • Cryosurgery is a medical process that involves subjecting the abnormal cells to very low freezing temperature. It is the most commonly used method for persistent cells.
  • Cone biopsy is the removal of triangulated area within which the abnormal cells exist.
  • Loop Electrosurgical Excision Procedure (LEEP) medical procedure is done by using a loop shaped tool to remove the area of abnormal cells.
  • In non-HPV related cases where inflammation is detected within the vagina, antibiotics would be prescribed to alleviate this inflammation. The patient would be required to return for a repeat Pap smear test to ascertain the problem has been completely eliminated.

In video below, Dr. Stephen Buckley and Dr. discussed abnormal Pap smear treatment and steps to take following an abnormal Pap smear results – depend on severity of cell changes.


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