HPV testing and pap smears: more than just pap smears

Photo: Pattarawimonchai

The annual Pap smear is used along with the HPV test for the early detection of cervical cancer. Anyone who goes to the gynecologist regularly knows the procedure. But what exactly is being investigated and what do the individual result levels mean?

Regular participation in cancer examinations is generally recommended to identify possible changes at an early stage and to be able to treat them better. These include the Pap smear and the HPV test to diagnose cervical cancer and its precursors early.

cervical cancer

Cancer of the cervix, also known as cervical carcinoma, is the fourth most common cancer in women worldwide. It is most commonly diagnosed between the ages of 35 and 44 and infection with the HP virus is the culprit in most cases. HPV 16 and HPV 18 are among the high-risk types responsible for up to 70 percent of cervical cancers. The viruses cause cell changes in the cervix that can develop from precancerous lesions to cervical cancer. This can last between ten to 15 years. Cervical cancer often causes no symptoms in the early stages, so the disease can go undetected for a long time without regular screening. In most cases, symptoms only appear when the cancer is already more advanced. If the following symptoms occur, a gynecologist should be consulted:

  • noticeable discharge, with possible unpleasant smell
  • stomach ache
  • pain when urinating
  • unusual weight loss
  • fatigue, exhaustion
  • Bleeding after intercourse (non-period)
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pap smear

The Pap test is part of the gynecological cancer examination and is covered by statutory health insurance. Women aged 20 to 34 have an annual entitlement. For women over 35, there is the so-called KO test, which includes both a Pap smear and an HPV test. This test is performed every 3 years and is also reimbursed by health insurance companies.


During the smear test, the gynecologist takes cells from the cervix and the cervical canal, which are then examined under a microscope in the laboratory for possible cell changes. In the event of an abnormal Pap finding, it may be decided whether further investigations are necessary depending on the result. It is important to note that an abnormal Pap result does not automatically mean a cancer diagnosis. Especially young women between the ages of 20 and 30 are more likely to experience slight cell changes, which can also be caused by inflammation, for example. It usually regresses. In these cases, people usually wait and monitor more.

Possible pap findings

porridge 0 Insufficient material
Pope I Unobtrusive and non-suspicious smear test results
Paper IIa Unremarkable smear findings. However, in the past there have been investigations with abnormalities
Chapter II Conditionally striking findings with minor cell changes. There is no pre-cancerous stage or cancer yet.
Chapter III No cancer cells were found, but striking changes were found that could not be clearly determined.
Pap IIID1 Clear cellular changes, but with a low risk of developing into cancer cells. Common finding in young women. Cell changes can often be regressive.
Pap IIID2 More severe cell changes, with a higher risk of developing cancer cells. It is less likely to go away on its own.
Pope IV Severely changed cells that are thought to be pre-cancerous or early stage cancer.
Pap IVb There is a high probability that cancer has developed and cancer cells have already spread.
Pope V Cancer cells have already been detected.

HPV test

The HPV test checks for a possible infection with human papillomaviruses. In addition, it can be determined whether there is an infection with HPV high-risk types. For the test, the Pap smear is examined for HPV at the same time.

HPV infections are especially common among young women. In most cases, the immune system is able to fight the infection and after a year or two the virus is no longer present. Therefore, a regular HPV test is normally only necessary for women over 35 to avoid possible overtreatment.

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If there is a positive result with one of the high-risk types, a closer examination for possible cell changes in the cervix is ​​recommended.

High-risk types include: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73 and 8.

HPV vaccination can provide protection against infection.



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