Pap Smear and Colposcopy

Human papillomaviruses (HPV) are among the most common sexually transmitted viruses worldwide. Most sexually active people come into contact with HPV during their lifetime. In most cases, the immune system clears the virus successfully. However, certain high-risk HPV types can cause cervical cell changes over many years. Depending on age and history, either the Pap smear or the HPV test is used – routinely combining both tests (co-testing) is no longer recommended, as it offers no relevant additional benefit but causes higher costs and more follow-up investigations.

Risk factors

• –Previous abnormal Pap results
• –Positive HPV test (particularly high-risk types)
• –History of dysplasia or conisation
• –Smoking
• –Weakened immune system

Frequency

HPV infections are very common. Precursor lesions requiring treatment occur in only a small proportion of infected women – particularly in younger women, many changes regress without treatment.

Typical symptoms

• –Early cell changes usually cause no symptoms
• –Rarely: intermenstrual bleeding or bleeding after intercourse
• –Changed discharge

Common incidental findings

• –Abnormal Pap result found during screening
• –Positive HPV test
• –Abnormal colposcopy at a follow-up examination

When is it detected?

Since precursor lesions are usually symptom-free, regular gynaecological screening is the most important way to detect them early.

Examinations

• –Pap smear (cervical cytology)
• –HPV test (high-risk types)
• –Colposcopy with acetic acid test and iodine test
• –Targeted biopsy of suspicious areas
• –Endocervical curettage if needed

What do the findings mean?

An abnormal Pap result does not automatically mean cancer. It simply shows that altered cells were found that should be assessed more closely. Possible causes include HPV infections, inflammation, temporary cell changes, or dysplasia (cancer precursors). Dysplasia refers to cell changes on the cervix; different severity grades are distinguished depending on the extent. Mild changes often regress spontaneously, while higher-grade changes may require close monitoring or treatment.

Watchful waiting

Mild dysplasia often regresses spontaneously and is initially monitored at closer intervals (Pap smear, HPV test, colposcopy if needed).

Medication

There is no causal drug therapy for HPV infection. Accompanying inflammation is treated specifically. Genital warts (condylomata acuminata) are treated with the established options – topical medication or removal. We discuss which approach fits in each individual case.

Surgery

Higher-grade dysplasia is usually removed with a minor procedure (LEEP/conisation). The procedure is usually performed on an outpatient basis and is well tolerated.

• –HPV vaccination – most effective before first sexual intercourse; in Switzerland a nonavalent (9-valent) vaccine is used, which protects against the most important high-risk HPV types
• –Catch-up vaccination is recommended up to the 27th birthday and fully covered by the cantonal vaccination programmes – vaccination can still be worthwhile after first intercourse
• –Above age 26 the vaccine is approved up to age 45, but not generally recommended: you bear the costs yourself and the benefit depends on your personal situation
• –Switching from the 4-valent to the 9-valent vaccine: costs are covered in Switzerland under the cantonal vaccination programmes up to the completed age of 26 (up to 26 years and 11 months)
• –In Switzerland the two-dose schedule (0/6 months) applies when vaccination starts between 11 and 14, and the three-dose schedule from age 15 – the earlier the vaccination, the better the immune response
• –Regular gynaecological screening (even after HPV vaccination)
• –Avoiding smoking
• –Safer sex reduces the risk of HPV transmission

• Annual check-up and Pap smear→

  Smear, HPV test and work-up of abnormal findings at the practice in Basel.

• Teen and first consultation→
• Gynaecological ultrasound→
• Cancer follow-up care→
• What we deliberately don't do→

• ↗BAG – HPV und Gebärmutterhalskrebs
• ↗Krebsliga Schweiz – Gebärmutterhalskrebs
• ↗SGGG – Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe
• ↗AG-CPC – Arbeitsgemeinschaft für Kolposkopie und Zervixpathologie