HPV test and pap smear: more than papperlapapp

Photo: Shutterstock.com/Orawan Pattarawimonchai

An annual Pap smear along with an HPV test is used to detect cervical cancer early. Everyone who goes to the gynecologist regularly knows the procedure. But what exactly is being tested and what do the individual result levels mean?

In general, regular participation in oncological examinations is recommended so that possible changes can be recognized in time and they can be treated better. These include the Pap smear and HPV test for early diagnosis of cervical cancer and its precursors.

cervical cancer

Cervical cancer, also known as carcinoma of the cervix, is the fourth most common cancer in women worldwide. It is most often diagnosed between the ages of 35 and 44, and in most cases, infection with the HP virus is to blame. HPV 16 and HPV 18 are among the high-risk types responsible for up to 70 percent of cervical cancers. Viruses cause cellular changes in the cervix that can progress from precancerous lesions to cervical cancer. This can take ten to 15 years. Cervical cancer often does not cause any symptoms in the early stages, so without regular screening, the disease can go undetected for a long time. In most cases, symptoms only appear when the cancer is more advanced. If the following symptoms appear, you should consult a gynecologist:

  • noticeable discharge with a possible unpleasant odor
  • abdominal pain
  • pain when urinating
  • unusual weight loss
  • fatigue, exhaustion
  • Bleeding after intercourse (without menstruation)

Pap smear

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


During the smear test, the gynecologist takes cells from the cervix and cervical canal, which are then examined in the laboratory under a microscope for possible cell changes. In the case of an abnormal Pap test, it can be decided according to the result whether further examinations are necessary. It is important to note that an abnormal Pap result does not automatically mean a diagnosis of cancer. Especially in young women between the ages of 20 and 30, mild cell changes occur more often, which can also be caused by, for example, inflammation. They usually recede. In these cases, people usually wait and watch more closely.

Possible pap findings

Pap 0 Insufficient material
Pope I Unobtrusive and unsuspicious smear test results
Paper IIa Unremarkable smear results. However, there have been investigations with abnormalities in the past
Chapter II Conditionally noticeable findings with minor cellular changes. There is no precancerous stage or cancer yet.
Chapter III No cancer cells were found, but striking changes were found that could not be clearly identified.
Pap IIID1 Clear cellular changes, but with a low risk of developing into cancer cells. A common finding in young women. Cell changes can often regress.
Pap IIID2 More serious cellular changes, with a higher risk of cancer cells. There is less chance of these going away on their own.
Pope IV Severely altered cells suspected of being precancerous or early stage cancer.
Pope IVb There is a high probability that cancer has developed and the cancer cells have already spread.
Pope V Cancer cells have already been detected.

HPV test

The HPV test checks for possible infection with human papillomaviruses. In addition, it can be determined if there is an infection with high-risk types of HPV. In the test, the Pap smear is also examined for HPV.

HPV infections are particularly common in young women. In most cases, the immune system is able to defend itself against the infection, and after a year or two the virus no longer occurs. Therefore, a regular HPV test is usually only necessary for women over 35 to avoid possible overtreatment.

If the result is positive for one of the high-risk types, a closer examination for possible cellular changes in the cervix is ‚Äč‚Äčrecommended.

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

Vaccination against HPV can provide protection against infection.

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