Pap and HPV test results: what they mean
An abnormal Pap test or a positive HPV test does not mean you have cancer. Most people with abnormal results have early cell changes that often go away on their own or can be treated early. What happens next depends on your result, your past results and your age, and your doctor decides. (NCI, 2024) (ACOG)
HPV test results
- Negative: high-risk HPV was not found. The next test is usually in 5 years, sooner if you had abnormal results in the past. (NCI, 2024)
- Positive: a high-risk HPV infection was found. It does not mean you have cancer now, but it may be a sign that cancer could develop later. (ACOG)
- HPV 16 or 18: these two types cause most cervical cancers; HPV typing tests look for them specifically. (ACOG) After an HPV 16 or 18 positive screening result, a colposcopy is needed even if the Pap is normal. An extra test on the same sample (such as a Pap) is preferred because it helps plan the colposcopy, for example a high-grade (HSIL) result may allow treatment without waiting for a biopsy; it does not replace the colposcopy. If that extra test cannot be done, you go straight to colposcopy. (ASCCP, 2020)
Pap test results, in plain words
| Result on your report | What it means | Usual next step |
|---|---|---|
| Normal (negative, NILM) | No abnormal cervical cells were found. | Routine screening (NCI, 2024) |
| Unsatisfactory | The sample may not have had enough cells, or they were clumped or hidden by blood or mucus. | Another Pap test in 2 to 4 months (NCI, 2024) |
| ASC-US (atypical squamous cells of undetermined significance) | The most common abnormal finding: some cells do not look completely normal. Irritation, some infections, polyps and hormone changes in pregnancy or menopause can also cause it. | Usually an HPV test to see whether HPV is the cause (NCI, 2024) |
| LSIL (low-grade squamous intraepithelial lesion) | Low-grade changes, usually caused by HPV. | Usually more testing to check there are no high-grade changes (NCI, 2024) |
| ASC-H (atypical squamous cells, cannot exclude HSIL) | Abnormal cells that may be high-grade, though it is not certain. | Usually a colposcopy (NCI, 2024) |
| HSIL (high-grade squamous intraepithelial lesion) | Moderately or severely abnormal cells that could become cancer in the future if not treated. | Usually a colposcopy (NCI, 2024) |
| AGC (atypical glandular cells) | Glandular cells that do not look normal; this can be a sign of a problem higher up inside the uterus. | Usually a colposcopy (NCI, 2024) |
| AIS (adenocarcinoma in situ) | An advanced lesion in the glandular tissue of the cervix that may become cancer if not treated. | Usually a colposcopy (NCI, 2024) |
The bodies word ASC-US a little differently. The NCI says it is not clear whether HPV causes the changes, since other things can make cells look abnormal. (NCI, 2024) ACOG says the changes are almost always a sign of an HPV infection. (ACOG)
What usually happens next: risk-based follow-up
Since the 2019 ASCCP guidelines, follow-up is based on your risk of serious cell changes, not only on your latest result. Your doctor also weighs your past test results, any past treatment and your age. (NCI, 2024) (ASCCP, 2020) Depending on that risk, you may be advised to:
- come back for a repeat HPV test or HPV and Pap cotest in 1 or 3 years;
- have a colposcopy, usually with a biopsy;
- have treatment for high-grade changes. (NCI, 2024)
In the guidelines, an immediate risk of 4% or more of severe changes (CIN 3 or worse) means colposcopy or treatment; below that, the 5-year risk sets a return in 1, 3 or 5 years. (ASCCP, 2020) For example, an HPV-negative ASC-US result with no known history can return in 3 years. For most people with a new HPV-positive ASC-US or LSIL result after a negative HPV test or cotest in about the past 5 years, a 1-year repeat test is recommended instead of colposcopy. (ASCCP, 2020) People younger than 25 are managed differently, because HPV infections and cell changes often clear on their own at that age. (ASCCP, 2020)
What a colposcopy is
The doctor uses a speculum to see the cervix, applies a vinegar solution to show abnormal areas, and looks closely with a colposcope, a magnifying lens with a bright light. It usually includes a biopsy, a small sample checked under a microscope. (NCI, 2024) More: after an abnormal screening result.
Questions people ask
Does an abnormal Pap test mean I have cancer?
No. An abnormal result means some cells look different from normal cells; it does not mean cancer. Most people with abnormal cervical screening results do not have cancer, and cancer is very rarely found in people screened at regular intervals. (NCI, 2024)
What does a positive HPV test mean?
A high-risk type of HPV was found. ACOG says this does not mean you have cancer now, but it may be a sign that cancer could develop later, so you may need follow-up testing. Your doctor recommends the next step based on your result and history. (ACOG) (NCI, 2024)
What does HPV 16 or 18 positive mean?
HPV types 16 and 18 cause most cervical cancers, and some HPV tests look for them specifically. With an HPV 16 or 18 positive screening result, the ASCCP guidelines say a colposcopy is needed even if other tests are normal. An extra test on the same sample (such as a Pap) is preferred because it helps plan the colposcopy, for example a high-grade (HSIL) result may allow treatment without waiting for a biopsy; it does not replace the colposcopy. If that extra test cannot be done, you go straight to colposcopy. (ACOG) (ASCCP, 2020)
I had negative HPV tests for years. Why is it positive now?
It is not necessarily a new infection; an HPV infection can become active again after many years. Researchers do not know whether a reactivated infection carries the same risk as a new one. (NCI, 2024)