10:10 am - 02/14/2007

Normal Pap Smear - STD Free?

So I got my first pap smear January 8 first gyno visit ever), and last week I got the postcard that says everything is normal, see you next year. So does a normal Pap mean I am STD free? Or are there some STDs that don't show up on a Pap smear?
Just to clarify, I have been sexually active for the last 2 years with the same person (male). He was my first, never been with anyone else. I told her I am sexually active. Over the past two years I have never noticed anything that may lead me to believe I have an STD or other problems down there. I am just curious on how thorough the Pap is.
Thank you!
mamaduckers 14th-Feb-2007 03:25 pm (UTC)
Pap smears look for abnormal cervical cells, which could indicate cancerous or pre-cancerous cells (SOMETIMES caused by a strain of HPV) they are not a STD test. The STD testing is a different type of test. All the post card means is that you have no visible abnormal cervical cells.
vsb 14th-Feb-2007 03:27 pm (UTC)
In my experience, they only look for abnormal cells which can be caused by HPV, unless you ask them to screen you for more. You can always call and see what they screened for, they should be able to tell you.
scien 14th-Feb-2007 03:32 pm (UTC)
Pap smears are not STI tests. They check for abnormal cells on the cervix which could be an early sign of cervical cancer. This abnormality is often caused by a virus called HPV, which is transmitted sexually, but it's not a test for HPV as such (not all abnormal cells are caused by HPV, and it's perfectly possible to have HPV but no signs on your cervix). I doubt they would screen you for more things without your requesting it, and certainly not without your permission.
mizzpyx 14th-Feb-2007 03:37 pm (UTC)
Pap smears are not STI tests. They test for abnormal cervical cells. STI tests are separate- you'll have to go and get a different test. STI tests generally consist of several vaginal/cervical swabs, and blood tests.
zachemja 14th-Feb-2007 04:04 pm (UTC)
So no STDs show up on Pap smears?
zachemja 14th-Feb-2007 04:40 pm (UTC)
Ok, thanks.
Thanks everyone for replying =)
frolicnaked 14th-Feb-2007 04:44 pm (UTC)
No, no STIs show up on pap smears. The only thing that will show up on the pap itself is the presence of abnormal cervical cells (if you have them), which are often caused by HPV but can have other causes as well. (I'm pulling this number out of my butt at the moment, but I seem to remember reading somewhere that approximately 80% of cervical dysplasia is caused by HPV. I'll get back to you with a source for that.)

Some health care providers will test for some STIs at the same time as they perform a pap smear, but this definitely isn't a nation or worldwide standard. It varies from practice to practice. And whenever I've had it done -- my NP routinely screens for chlamydia and gonorrhea -- the staff has made sure I know this beforehand.

If your doc didn't say anything beforehand, it's very possible that no actual STI screenings were done. If you want to make very sure, though, you can always call your clinic to ask. :)
marionravenwood 14th-Feb-2007 05:35 pm (UTC)
I'm pulling this number out of my butt at the moment, but I seem to remember reading somewhere that approximately 80% of cervical dysplasia is caused by HPV. I'll get back to you with a source for that.)

I'ts more than that. The figures you read online vary, but it's usually 95% to "virtually all."
frolicnaked 15th-Feb-2007 02:53 am (UTC)
Do you have a source for this? Because while I'm finding sources -- like this one from the BBC -- that list HPV as the cause of 99%+ cases of cervical cancer, I'm not seeing the same figures for cervical dysplasia.

Sources like the National Library of Health and the University of Maryland Medical Center mention a strong link between HPV and dysplasia exists but also allow that additional factors must be taken into consideration. This article abstract from the Journal of the National Cancer Institute (UK) lists the figure as 76%. But the article in question is from 1993, and more recent information may be available. And this site lists 80-90% as the number, though I'm definitely not inclined to trust that info on its own.
marionravenwood 15th-Feb-2007 03:46 am (UTC)
You're right, the numbers I'm thinking of are for HPV causing cervical cancer, and I assumed they would be the same.
HPV is an "absolute requirement" for cervical cancer to develop.

But I also have this:

n more than 99 percent of cases, cervical cancer and cervical dysplasia are caused by the human papillomavirus (

Now I'm really confused because my understanding is that cervical dysplasia is only worrisome because it can be a precursor to cancer, so why would the causes be different. In other words, here are possible scenarios after HPV infection

HPV-->your body clears it on it's own--->you're fine
HPV-->progresses to cervical dysplasia--->your body clears it on it's own and/or you get treatment from a doctor--->you're fine eventually
HPV-->progresses to cervical dysplasia-->progresses to cervical cancer.



frolicnaked 15th-Feb-2007 07:01 am (UTC)
Thanks. The article you linked to (the second one) actually does list sources, and I tried to look up the one cited for the 99% stat. I didn't see it in the abstract, but I'm going to bet it's somewhere in the full text. (Not willing to pay the $25 to find out.) ;)

I think cervical dysplasia is still worrisome as a precursor to cervical cancer because HPV is still the major cause of both. In a sense, the numbers differences we're discussing are kind of inconsequential since if one develops dysplasia, it's still more than likely from HPV. It would make sense that medical professionals would act on that assumption.
foureyeddarlin 15th-Feb-2007 03:32 pm (UTC)
Check out the ALTS trial for statistics on HPV by Pap result (i.e. ASCUS is related to HPV ~50% of the time, LSIL is 80%, HSIL is higher.)

http://www.cancer.gov/prevention/alts/index.html
frolicnaked 16th-Feb-2007 02:53 am (UTC)
Awesome! Thanks for this! :)
jennifer0246 14th-Feb-2007 11:04 pm (UTC)
ASHA says almost always; other sources say 95 - 99% of dysplasia is caused by HPV.
frolicnaked 15th-Feb-2007 02:57 am (UTC)
Thanks for the ASHA link. I should read more closely sometimes. ;)

As for the 95-99% figure, if you check this comment, I haven't been able to find any sources that give either of those numbers. Do you happen to know where I could find them?
marionravenwood 15th-Feb-2007 04:01 am (UTC)
Yeah, the article I linked to didn't list sources.

This doctor says 95%.

frolicnaked 15th-Feb-2007 07:26 am (UTC)
Actually the article does list sources; you just have to click on the "references" link on the top. (Oh, and access it as a web page rather than as the HTML version of a PDF.) I'm actually half tempted to try to track down the source in question (wondering if I can access the full text at my school or my library).

I mean, it certainly makes sense that HPV would cause 95%+ cases of cervical dysplasia. I just haven't seen the research that supports it. And, of course, now I'm on a quest to find answers. ;)

But if I'm reading this doc's answer correctly, isn't he still talking about cervical cancer and not cervical dysplasia?
jennifer0246 15th-Feb-2007 04:04 am (UTC)
Research-fu is weak, but I did find http://www.lef.org/protocols/female_reproductive/cervical_dysplasia_01.htm, which states the > 99% figure, and http://healthcenter.uoregon.edu/patientinfo/sexual_health/Human%20Papilloma%20Virus%20of%20the%20Cervix.pdf which states "dysplasia is ... caused by HPV infection", inferring that there is no other cause. I'd also add that LGSIL and HGSIL pap results (those which would also be called 'dysplasia') aren't often even tested for HPV, as it's assumed in the medical community that those abnormalities are caused by infection with HPV. A medical provider I'm familiar with once told me that more than 99% of those categories of dysplasia (low and high grade squamous lesions) are caused by HPV.

In typical disjointed fashion, those are my sources :)
frolicnaked 15th-Feb-2007 07:35 am (UTC)
And in typical "anal retentive research bender" fashion, I'm going to try to find the full text of the article referenced in the first link. Will keep you posted if I read anything conclusive. :)
marionravenwood 15th-Feb-2007 03:56 am (UTC)
The only thing that will show up on the pap itself is the presence of abnormal cervical cells (if you have them), which are often caused by HPV but can have other causes as well.

re: "other causes" When abnormal cells on a pap aren't caused by HPV, they're a result of irritation (from sex, spermicides, cancer, tampons, you name it) infection (say, from a yeast infection) or contamination (something else got mixed in with the cells and made them look wrong. The something else could be blood from your period or douche or spermicide or whatever.) In these cases, the patient could get a false positive: your pap looked abnormal, but there's actually nothing wrong with the cervix.
elettaria 15th-Feb-2007 04:38 pm (UTC)
If he's never been with anyone else and you're 100% sure that he's telling the truth, I wouldn't start worrying about STIs (though smear tests are still wise, there are other things they can pick up). If you mean that you'd never been with anyone else then your partner could potentially have STIs. If you don't know it already, find out his sexual history, and if there's any space for doubt then it wouldn't hurt to get tested. Plenty of STIs may be asymptomatic for years, most notably chlamydia, which is terribly widespread these days and which is the leading cause of infertility (if it goes untreated for a long time, it can get nasty. Thankfully it's easily treated if caught early).
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