Pap Smear vs HPV Test: Understanding the Difference for Better Cervical Health

Cervical cancer screening looks very different than it did decades ago. Two tests stand at the forefront of preventative care: the Pap smear and the HPV test. They both help prevent cervical cancer, but in different ways.

It’s easy to misunderstand the tests or think they’re the same. However, they’re not. By learning what each test does, when to get it and how they differ, you can make educated choices about your health. Here’s what you need to know. 

What Is a Pap Smear?

pap-smear-vs-hpv-test-understanding-the-difference-for-better-cervical-healthA Pap smear (also known as Pap test or cervical smear) detects abnormal cells on the surface of your cervix. Pap stands for Dr George Papanicolaou, who first introduced this test in the 1940s.

The Pap smear checks for abnormal cells that may become cervical cancer if they are not treated.

Your doctor gently scrapes cells from your cervix using a small brush or spatula and then sends them to a lab to look for abnormal cells when viewed through a microscope.

Here's what the Pap smear detects:

• Precancerous cells (dysplasia)

• Early signs of cervical cancer

• Cell abnormalities caused by infection or inflammation

• Atypical cells that need monitoring

The test has been a game changer in cervical cancer prevention. Since its widespread use, cervical cancer rates have dropped by more than 60% in countries with regular screening programmes.

What Is an HPV Test?

The HPV test works differently. Rather than screening for abnormal cells, it looks for the virus that causes most cervical cancers: human papillomavirus, or HPV.

HPV is extremely common. Most sexually active people will get HPV at some point in their lifetime. According to the NHS, about 8 in 10 people will contract HPV at some point. Your body normally fights off the infection by itself within two years.

But certain high-risk strains of HPV (especially HPV 16 and 18) can remain in your body and cause changes to cells that lead to cancer. The HPV test looks for these high-risk strains of the virus in your body.

An HPV test is performed using the same method as when you give a doctor or nurse a Pap smear. They’ll use a brush to swab some cells from your cervix. The key difference is what they do with the sample: They test it for the presence of viral DNA, not abnormal cells.

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Pap Smear vs HPV Test: Key Differences

Understanding the distinction between these tests matters. Here's how they compare:

What They Detect

The Pap smear finds cellular changes. It shows what's already happening in your cervical cells. The HPV test finds the virus that might cause future changes. It shows your risk of developing problems down the road.

Think of it this way: the Pap smear is like checking for smoke, while the HPV test looks for the fire hazard itself.

Timing and Frequency

NHS cervical screening guidelines in the UK recommend:

• Ages 25 to 49: Screening every 3 years (typically Pap smear)

• Ages 50 to 64: Screening every 5 years (typically HPV test first)

• Ages 65+: Screening may stop if recent results are normal

At myGynaePlus, screening protocols follow these national guidelines while offering personalised care based on your individual risk factors.

Sensitivity and Specificity

The HPV test is more sensitive than the Pap smear. It's better at detecting people who will develop precancerous changes. Studies show HPV testing catches up to 95% of cervical cancers, compared to about 55% for Pap smears alone.

However, the Pap smear is more specific. It produces fewer false positives because it only flags actual cell changes, not just the presence of a common virus that usually goes away on its own.

What Happens After an Abnormal Result

An abnormal Pap smear usually means you need a colposcopy (a closer examination of your cervix) or a repeat test in 6 to 12 months. The next steps depend on the severity of the cell changes.

A positive HPV test doesn't always mean immediate action. If you're under 30, your doctor might recommend retesting in a year since young women commonly clear HPV infections naturally. If you're over 30 or have a high-risk HPV type, you might need a Pap smear or colposcopy to check for cell changes.

Co-Testing: Using Both Tests Together

Some screening programmes use both tests at the same time. This approach, called co-testing, offers the strongest protection against cervical cancer and is often recommended by a Private Gynaecologist in London as part of a comprehensive women’s health assessment.

Co-testing works best for women over 30. At this age, persistent HPV infections are more concerning because they are less likely to clear on their own. Using both tests together:

• Increases detection rates

• Reduces the chance of missing precancerous changes

• Allows for longer screening intervals (up to 5 years) when both tests are negative

The downside? Co-testing can lead to more follow-up appointments and procedures, which can cause anxiety and discomfort.

HPV Primary Screening: The Newer Approach

The UK has shifted to HPV primary screening for most age groups. This means the HPV test comes first. If HPV is detected, your sample is then checked for abnormal cells.

Why the change? Research shows that HPV testing is better at preventing cervical cancer. A large study published in The Lancet found that HPV screening reduced cervical cancer rates by 60-70% compared to Pap smears alone.

The HPV-first approach works like this:

1. Your sample is tested for high-risk HPV types

2. If negative, you're screened again in 3-5 years (depending on age)

3. If positive, the same sample is examined for cell changes

4. Treatment or monitoring is recommended based on the results

This method is more efficient and catches more cases earlier. myGynaePlus follows these evidence-based protocols to provide the most effective screening available.

Which Test Do You Need?

The answer depends on your age, health history, and previous screening results.

For Women Under 25

Routine cervical screening isn't typically recommended. HPV infections are extremely common in this age group and usually clear without treatment. Screening younger women can lead to unnecessary procedures.

For Women 25 to 29

Most guidelines recommend Pap smears every three years. HPV testing might be used if your Pap results are unclear or abnormal.

For Women 30 to 65

HPV testing is the primary screening method, often combined with a Pap smear if HPV is detected. Many programmes offer co-testing every five years as an alternative.

For Women Over 65

You might stop screening if you've had consistently normal results. However, if you have a history of abnormal cells or missed previous screenings, your doctor might recommend continuing.

Special Circumstances

You might need different screening if you:

• Have a weakened immune system

• Were exposed to diethylstilbestrol (DES) before birth

• Have had cervical cancer or precancerous cells

• Are living with HIV

At myGynaePlus, individualised screening plans take these factors into account.

Common Myths About Cervical Screening

Let's clear up some confusion.

1. Myth: If I've had the HPV vaccine, I don't need screening. The vaccine protects against certain HPV types but not all of them. You still need regular screening.

2. Myth: I only need screening if I have symptoms. Cervical cancer rarely causes symptoms in its early stages. Screening catches problems before you notice anything wrong.

3. Myth: I'm too old to need screening. Age matters, but so does your screening history. Some women over 65 still need testing.

4. Myth: The tests are painful. Most people find the tests uncomfortable but not painful. The procedure takes less than five minutes.

   
   

Making Screening Easier

Many people avoid cervical screening because they feel embarrassed or anxious. Here are some tips:

• Book with a female doctor or nurse if that makes you more comfortable

• Ask questions before the test so you know what to expect

• Practice relaxation techniques like deep breathing

• Remember that the medical team performs these tests every day and wants you to feel at ease

• Schedule your appointment when you won't have your period

If you've had a traumatic experience or have severe anxiety about the procedure, speak with your healthcare provider. They can offer additional support or alternative arrangements.

The Bottom Line on Pap Smear vs HPV Test

But they don’t do the same thing. The Pap smear detects abnormal cells that are already present. The HPV test detects the virus that could lead to abnormal cells in the future.

HPV testing is becoming more common in modern screening programmes because it’s more sensitive than a Pap smear, and you can go longer between tests. But Pap smears are still useful, especially for determining what’s going on when HPV is found.

In most cases, you won’t have to pick. Your doctor will recommend whichever test(s) is most appropriate for you (based on your age, risk factors, etc.). Remember, the best screening test is the one that you actually complete.

Whether it’s Pap smears, HPV testing, or a combination of both, regular screening is still the best tool we have for preventing cervical cancer. Early detection is key. 

Frequently Asked Questions

Can I get both tests at the same appointment? 

Yes, both tests use cells collected from your cervix during a single examination. The sample can be tested for abnormal cells (Pap smear) and HPV virus simultaneously. This is called co-testing and is common for women over 30. You won't need two separate appointments or procedures.

How accurate is the HPV test compared to a Pap smear? 

The HPV test is more sensitive, detecting about 95% of cervical cancers versus 55% for Pap smears alone. However, it's less specific, meaning it may flag infections that would clear naturally. That's why positive HPV results are often followed by Pap testing to check for actual cell changes.

If my HPV test is positive, does that mean I have cancer? 

No. A positive HPV test means you have a high-risk HPV type, not cancer. Most HPV infections clear on their own. You'll likely need follow-up testing to check whether the virus has caused any cell changes. Only persistent infections with certain HPV types lead to precancerous changes or cancer.

Why did cervical screening guidelines change from Pap smears to HPV testing? 

Research showed HPV testing prevents more cancers and allows safer intervals between tests. Because HPV causes nearly all cervical cancers, detecting the virus early identifies who's at risk before cell changes appear. This lets doctors monitor or treat people more effectively and reduce unnecessary procedures for others.

Do I still need screening if I'm in a monogamous relationship? 

Yes. HPV can remain dormant for years before being detected. You may have contracted it from a previous partner, even decades ago. Regular screening remains important regardless of your current relationship status. Past exposure, not just current activity, determines your risk for HPV-related cell changes.