A lot of women leave their annual gynecology visit knowing they had “a Pap smear” — and not much else. Whether an HPV test was also done, what exactly was being looked for, and how often they actually need to come back for screening are details that often get lost in the middle of an appointment.
That’s a gap worth closing, because the two tests are different in what they detect, the guidelines for when each is used have recently changed, and understanding the results of either one depends on understanding what each test was actually looking for in the first place.
This article breaks down what a Pap smear and an HPV test each do, how they’re used together, what the current screening guidelines say by age group, and what happens if a result comes back abnormal.
What a Pap Smear Does
A Pap smear — also called a Pap test or cervical cytology — is a test that collects cells from the surface of the cervix and examines them under a microscope for abnormal changes. It is not a test for HPV. What it looks for is evidence of cellular changes in the cervix that could indicate precancer or cancer.
Those cellular changes happen on a spectrum. Mild abnormalities — sometimes referred to by results like ASCUS (atypical squamous cells of undetermined significance) or LSIL (low-grade squamous intraepithelial lesion) — are common and often resolve on their own. More significant changes, labeled HSIL (high-grade squamous intraepithelial lesion), indicate a higher level of abnormality that generally requires closer evaluation. A Pap smear that identifies these changes early gives an opportunity to intervene before they progress to cervical cancer.
The Pap smear has been one of the most effective cancer screening tools ever developed. Before widespread cervical cancer screening became routine, cervical cancer was one of the most common causes of cancer death in women in the US. Regular Pap testing dramatically reduced that number over the past several decades.
What an HPV Test Does
An HPV test looks for the presence of human papillomavirus — specifically the high-risk strains that are known to cause cervical cancer. It does not look at the cells themselves. It detects the virus.
HPV is the most common sexually transmitted infection in the United States, and nearly all cases of cervical cancer are caused by persistent infection with high-risk HPV strains. The most common high-risk types are HPV 16 and HPV 18, which together are responsible for the majority of cervical cancers.
Most HPV infections clear on their own. The immune system eliminates the virus without any symptoms, treatment, or lasting effects. The problem arises when a high-risk HPV infection persists over years, because that persistent infection is what gradually causes the cellular changes that can lead to cancer. This is why detecting HPV early — before it has had time to cause significant cellular damage — has become central to cervical cancer prevention.
The HPV test is more sensitive than a Pap smear for detecting the risk of cervical cancer development. It can identify a high-risk infection even before the cells have changed noticeably, which is why it’s increasingly used as the primary or preferred screening method.
Co-Testing: When Both Are Done Together
Co-testing means having both a Pap smear and an HPV test performed at the same visit, using the same cervical cell sample. The two tests complement each other: the Pap looks at the cells, and the HPV test looks for the virus. Together, they provide a more complete picture of cervical health than either test alone.
Co-testing has been a widely used approach for women in their 30s and older and remains one of the accepted options in current screening guidelines. It’s typically done every five years when both tests come back negative.
What the Current Screening Guidelines Say
Cervical cancer screening guidelines have evolved significantly in recent years, and the 2025–2026 updates from major health organizations have shifted the recommendations in a meaningful direction. If you’ve been following guidance from a few years ago, it’s worth knowing what’s changed.
Ages 21 to 29
For women in this age group at average risk, the recommendation is a Pap smear alone every three years. HPV testing is not part of routine screening for this age group. This is because HPV infections are very common in younger women and usually clear on their own — the risk of a transient infection leading to unnecessary treatment is higher, and the benefit of HPV testing in this group is lower.
Ages 30 to 65
This is where the guidance has changed most significantly. As of 2025–2026, the preferred screening method for average-risk women aged 30 to 65 is now primary HPV testing — an HPV test alone, every five years. This is the recommendation from both HRSA (updated January 2026) and the American Cancer Society.
The Pap smear is more sensitive than HPV testing for detecting immediate cellular abnormalities. But the HPV test is better at identifying the underlying viral risk before cells have changed — and since that risk develops slowly, a five-year interval with HPV testing provides strong protection when results are negative.
Women in this age group still have two other accepted options:
- Co-testing (Pap + HPV) every five years — combines both tests at the same visit; still widely used and recommended as an acceptable alternative
- Pap smear alone every three years — still acceptable when other options aren’t available or preferred
If you’re unsure which approach is right for you, the answer depends on your prior results, personal history, and what you’ve been doing with your provider. The most important thing is that screening is happening on a regular schedule — not which specific test is used.
Age 65 and Older
Most women who have been getting screened regularly and have had consistently normal results can stop cervical cancer screening at 65. “Regularly” generally means at least three consecutive normal Pap results, two consecutive negative HPV tests, or two negative co-tests — all within the past ten years, with the most recent within the past five.
Women who have had a history of cervical cell abnormalities, or who have not had adequate prior screening, should continue beyond 65 and discuss timing with their provider.
What About HPV Vaccination?
The HPV vaccine significantly reduces the risk of infection from the most dangerous HPV strains. But it does not protect against all high-risk strains, and it doesn’t eliminate prior infections. Cervical cancer screening is still recommended for all women — vaccinated and unvaccinated — following the same age-based guidelines. The vaccine and the screening work together; one does not replace the other.
A New Option: HPV Self-Collection
One of the more significant recent developments in cervical cancer screening is the availability of self-collected HPV testing. The FDA approved at-home self-collection kits in 2025, allowing women to collect their own cervical sample privately — either at home or in a clinical setting — and have it tested for high-risk HPV.
This option is specifically designed for HPV-primary screening in women aged 30 to 65 at average risk. It is not a Pap smear, and it does not replace clinical evaluation for women with symptoms, prior abnormal results, or other concerns. But for women who have delayed screening because of discomfort with pelvic exams, logistical barriers, or past negative experiences with clinical settings, self-collection is a meaningful step toward keeping up with screening.
If a self-collected HPV test comes back positive, follow-up with a provider for further evaluation is still required. A positive test is not a diagnosis — it’s a signal that more information is needed.
Understanding Your Results
One of the most anxiety-producing parts of cervical cancer screening is waiting for results and then not fully understanding what they mean. Here’s a plain-language breakdown of the most common result categories:
Normal / Negative
A normal Pap result means no significant abnormal cells were detected. A negative HPV result means no high-risk HPV strains were found. Either result means you can follow the standard screening interval for your age group without needing any additional evaluation.
ASCUS (Atypical Squamous Cells of Undetermined Significance)
ASCUS on a Pap result means some cells looked mildly different from normal, but not definitively abnormal. It’s a common, low-concern finding — often caused by inflammation, infection, or minor changes that resolve on their own. Depending on your age and whether HPV testing was done alongside the Pap, your provider may recommend a repeat Pap in a year, HPV testing, or simply a follow-up at your next scheduled screening. Most ASCUS results don’t lead to anything further.
LSIL (Low-Grade Squamous Intraepithelial Lesion)
LSIL indicates mild cervical cell changes. In younger women, these often clear without treatment. In women 30 and older, LSIL may prompt a referral for colposcopy — a closer examination of the cervix — to evaluate whether the changes need monitoring or treatment. It does not mean cervical cancer has been found.
HSIL (High-Grade Squamous Intraepithelial Lesion)
HSIL indicates more significant abnormal cell changes that are less likely to resolve on their own and require follow-up evaluation. A colposcopy — and often a biopsy — is typically recommended to determine the extent of the abnormality and whether treatment is needed. HSIL is a pre-cancerous finding, not cancer itself, but it does require timely attention.
Positive HPV Test
A positive HPV test means a high-risk HPV strain was detected. It does not mean you have cervical cancer. Most HPV infections — even high-risk ones — are cleared by the immune system within one to two years. What a positive result does mean is that closer monitoring is warranted, and your provider will discuss next steps, which may include a repeat test in one year, co-testing, or colposcopy depending on which strain was found and what prior results show.
What Happens After an Abnormal Result
If any result comes back abnormal — whether that’s an atypical Pap, a positive HPV test, or both — the most important thing to understand is that an abnormal result is not the same as a cancer diagnosis. Cervical cancer screening is designed to detect problems early, often years before cancer develops, precisely so that straightforward interventions can prevent progression.
Depending on the result, next steps might include:
- A repeat test in 6–12 months — for mild findings that may resolve on their own
- A colposcopy — a procedure done in the office where a special instrument magnifies the cervix for a closer look; usually painless or minimally uncomfortable, and takes about 15 minutes
- A biopsy — a small tissue sample taken during colposcopy to examine under a microscope and determine the grade of any abnormality
- Treatment — if pre-cancerous cells are confirmed, procedures like LEEP (loop electrosurgical excision procedure) can remove the abnormal tissue, effectively stopping progression before cancer develops
An abnormal result opens the door to monitoring and, if needed, early treatment. That is exactly what screening is for.
Frequently Asked Questions
- Do I need both a Pap smear and an HPV test every time I come in?
Not necessarily, and not every year. The specific test — or combination of tests — you need depends on your age and how your most recent screening came out. For women 21 to 29, a Pap alone every three years is the standard. For women 30 to 65, primary HPV testing every five years is now the preferred approach, though co-testing (Pap plus HPV) every five years is also accepted. Your provider will let you know which is appropriate for you and when you’re actually due.
- Can I skip a Pap smear if I’ve been vaccinated against HPV?
No. The HPV vaccine reduces risk significantly, but it doesn’t protect against every high-risk strain, and it doesn’t affect any infections that occurred before vaccination. Cervical cancer screening is recommended for all women on the same schedule regardless of vaccination status. The vaccine and the screening are both important — they address different parts of the risk.
- What does it mean if my Pap is normal but my HPV test is positive?
It means no abnormal cells were detected, but a high-risk HPV strain is present. This is a recognized combination in screening — it suggests the infection hasn’t yet caused detectable cell changes, but warrants follow-up to make sure it clears or doesn’t progress. Your provider will typically recommend a repeat test in one year or additional evaluation, depending on which HPV strain was found. It is not cause for immediate alarm, but it does require monitoring.
- How long does it take to get Pap and HPV results?
Most results are available within one to two weeks and are typically communicated through the patient portal, a letter, or a follow-up call. If the result requires any further evaluation, your provider’s office will reach out to discuss next steps. If you haven’t received results within two weeks, it’s reasonable to follow up with the office.
- At what age can I stop getting Pap smears?
Most women at average risk with a history of regular, normal screening can stop at age 65. This applies when you’ve had at least three consecutive normal Pap results, two negative HPV tests, or two negative co-tests in the past ten years — with the most recent result in the past five years. Women with a history of abnormal results, prior cervical cancer, or inadequate past screening may need to continue beyond 65 and should discuss their specific situation with their provider.
- Is the HPV test the same as STD screening for HPV?
The high-risk HPV test used in cervical cancer screening specifically looks for the strains of HPV linked to cervical cancer. It is not a general STD test for all types of HPV. There are over 100 strains of HPV, only about 13 of which are considered high-risk for cancer. There is no approved test to screen for low-risk HPV strains in clinical settings, and most people clear HPV infections naturally. If you have questions about HPV or STD screening more broadly, that’s a conversation worth having at your next visit.
Conclusion
Pap smears and HPV tests are both tools for preventing cervical cancer — they just work differently, look for different things, and are recommended on different schedules depending on your age and history. Understanding what each test does makes it easier to understand your results, ask informed questions, and stay on top of screening without over- or under-doing it.
The guidelines have shifted in a meaningful direction recently, with primary HPV testing now the preferred method for women 30 and older and self-collection becoming a new option for eligible women. The most important thing hasn’t changed: regular screening, consistently done, is one of the most effective things you can do for your long-term health.
If you’re not sure when you’re due for your next Pap smear or HPV test, or if you have questions about a recent result, bring it up at your next annual exam. At KEM Health, we’re happy to walk through what your results mean and what, if anything, needs to happen next.