Even though most abnormal Pap tests are caused by an HPV infection that will go away or an inflammation that can be treated, you will need a follow-up evaluation to make sure your abnormal cell changes have resolved. Your need for treatment will vary depending on whether your abnormal cell changes are mild, moderate, or severe. Abnormal Pap test results may show minor cell changes (most common), moderate to severe cell changes (less common), or cervical cancer (rare). Depending upon the cause and severity of the cervical cell changes, treatment may be necessary.

Human papillomavirus (HPV) infection is the most common cause of an abnormal Pap test. There are many types of HPV; high-risk types can cause cell changes that could develop into cancer.

Evaluation of minor cell changes (ASC-US and LSIL)

An abnormal Pap test result is not uncommon because HPV infection is very common. About 5% to 10% of women who have a yearly Pap test will have an abnormal Pap result, but only a small percentage of these abnormal results indicate changes that may progress to cervical cancer. If your abnormal Pap test shows minor cell changes, you may have several choices of what to do next.

If your Pap test shows that a vaginal infection or a treatable sexually transmitted disease (STD) is present, you can be treated with medicine.

Evaluation of ASC-US. If you have had a Pap test only and your test results show atypical squamous cells of undetermined significance (ASC-US), you can:

• Choose watchful waiting, which includes repeat Pap tests every 4 to 6 months. Watchful waiting will not be harmful if the abnormal tissue is not visible on the cervix or a type that is not likely to progress to cancer and you do not have an impaired immune system. Regular use of condoms during this time will increase the chance that abnormal cells will go away on their own.²
• Have a test for high-risk human papillomavirus (HPV) types. The natural course of most types of HPV is to resolve on their own within 18 months. HPV in women younger than 30 usually goes away on its own. HPV in women older than 30 is more likely to persist. Minor cell changes not related to high-risk HPV may not be significant and often go away. Even if you have a high-risk HPV type, more severe cell changes may never develop because high-risk HPV infections can also go away on their own. But if testing shows a high-risk HPV, your doctor will probably recommend a colposcopy and possibly cervical biopsy to look at the abnormal cells. If you do not test positive for a high-risk HPV, you can return to a normal screening schedule.⁷
• Have a colposcopy so your doctor can look at the abnormal cells. A cervical biopsy may be done at the same time to confirm the colposcopy findings. Women with HIV infection will most likely be evaluated with colposcopy and then treated for any abnormal cervical cells.