HPV test vs Pap smear

An HPV test looks for high-risk types of human papillomavirus linked with cervical cell changes. A Pap smear, also called cervical cytology, examines cells collected from the cervix for abnormalities. Both use a sample taken during a speculum examination, and they may be performed together or as part of a screening pathway. Neither test is a general test for every sexually transmitted infection.

An HPV test may be used when the screening pathway is designed to identify high-risk HPV before cell changes become apparent, or when a previous cervical sample needs a follow-up test. Some programmes use HPV testing as the first screening step, while others use it alongside cytology. A positive result means HPV was detected; it does not establish cancer. Details are available in [HPV Test](/treatments/diagnostics-and-imaging/hpv-test/).

A Pap smear may be used when the immediate question is whether cervical cells look abnormal. It can be part of co-testing, a follow-up pathway, or a screening programme that uses cytology first. The sample may be reported as adequate, inadequate or showing a degree of cell change, and the next step depends on the complete result and previous records. See [Pap Smear](/treatments/cancer-screening/pap-smear/).

Sampling can cause brief pressure, discomfort or light spotting. An HPV test can detect an infection that may clear without causing cell changes, so the result may require context and follow-up rather than immediate treatment. A Pap smear can miss abnormal cells if the sample is inadequate or the changes are not captured. An abnormal result is not the same as a cancer diagnosis, but it should be followed through according to the recommended pathway.

Screening is for people without symptoms. Bleeding after sex, bleeding between periods, unusual discharge, persistent pelvic pain or a visible cervical concern needs a clinical assessment even if a recent screening result was normal. A clinician may examine the cervix and request tests selected for the symptom. Do not wait for the next routine screen when a new or persistent symptom needs review.

The recommendation depends on the screening programme, age group, prior results, vaccination and treatment history, pregnancy status, and whether symptoms are present. The clinician also checks whether the sample was adequate and whether follow-up has already been advised. Ask what the result means, when follow-up is due, and where the result will be recorded. Keep copies of prior cervical results when changing providers.