Key Takeaways
- Pap smears detect abnormal cervical cells, while HPV tests identify high-risk HPV strains that may lead to cervical cancer.
- Pap tests typically begin at age 25 and are recommended every 3 years if results are normal.
- HPV testing is advised from age 30, with a recommended interval of every 5 years, either alone or as part of co-testing with a Pap smear.
- Both tests use the same sample collection method, involving a gentle swab of cervical cells during a pelvic exam.
- A normal Pap or HPV test result means low risk of cervical cancer and allows for the recommended intervals between screenings.
According to the World Health Organisation, cervical cancer ranks as the fourth most common cancer among women worldwide, with an estimated 660,000 new cases and 350,000 deaths reported in 2022. Despite being highly preventable and treatable when detected early, cervical cancer continues to claim lives, often due to a lack of awareness and limited access to cervical cancer screening.
Early detection through women’s health screening plays an important role in reducing both incidence and mortality rates. Two of the most widely used screening methods are the Pap smear and the HPV (human papillomavirus) test.
While both aim to detect early signs of cervical abnormalities, they differ in what they detect, how often they’re recommended and who should undergo them.
Understanding the key differences between the Pap smear and HPV test can empower you to make informed decisions about your reproductive health. In this blog, we’ll break down how each test works, what they’re used for and which one might be right for you.
Let’s start by defining each test, beginning with the Pap smear.
What is a Pap Smear?
Image Source: National Cancer Institute
Also called a Pap test, a Pap smear is a screening procedure that checks for abnormal or precancerous cells on the cervix. The cervix is the narrow, lower part of the uterus that connects to the vagina. A Pap test is used for cervical cancer screening and can detect it early, when treatment is most likely to be effective.
How is a Pap Test Performed?
A Pap smear is typically done at a healthcare professional’s office or a clinic. The entire process usually takes only a few minutes. Here’s what you should expect:
- You’ll be asked to lie on your back on an exam table with your knees bent and feet placed in stirrups to gently open the vaginal canal.
- The healthcare provider will insert a speculum—a smooth, plastic or metal device—into the vagina. This instrument gently separates the vaginal walls to give a clear view of the cervix.
- Using a small brush or spatula, the provider will gently scrape a sample of cells from the surface of the cervix. This process may cause a mild sensation of pressure or discomfort, but it is usually not painful and takes just a few seconds.
- The collected cells are then placed in a solution or on a glass slide and sent to a laboratory for examination.
- You can return to your normal activities immediately after a Pap smear. Some people may experience light spotting or mild cramping, which typically resolves quickly.
Keep in mind that you need to avoid certain activities 24 to 48 hours before the test. This includes sexual intercourse, douching and using vaginal creams or medications, as these can affect the accuracy of the results.
It’s usually recommended to schedule a cervical cancer screening 7 to 10 days after your menses.
Who Should Undergo a Pap Test?
The test is generally recommended for most individuals with a cervix who has ever had sexual intercourse.
Women In Their 20s
Pap testing typically begins at age 25. Have the Pap test repeated every three years. HPV test is usually not done as at this age, the body is able to clear HPV infections at a faster rate.
Women Aged 30 to 65
At this stage, you have more screening options:
- Pap test alone every 3 years, or
- HPV test alone every 5 years, or
- Co-testing (Pap + HPV) every 5 years
The current recommendation in Singapore is HPV test alone once every 5 years.
Discuss with your doctor which option is best based on your health history and preferences.
Women At 69
You may be able to stop cervical cancer screening if:
- You’ve had at least three normal Pap tests in a row, or
- You’ve had two consecutive HPV tests in the past 10 years, with the most recent within the last 5 years.
However, if you have a history of cervical cancer or precancer, continued testing may still be recommended.
What Happens After The Test?
Your Pap smear results will fall into one of the following general categories:
- Normal
No abnormal or precancerous cells were found. This means your cervix appears healthy. If you’re at average risk, your next Pap test is usually scheduled in three years (or five years if you had co-testing with HPV).
- Abnormal
If there are abnormalities, your healthcare provider will advise you regarding the next step in management and treatment.
What is an HPV Test?
An HPV test is a diagnostic screening used to detect the presence of high-risk types of human papillomavirus (HPV)—a group of viruses that can cause cervical cancer. Unlike the Pap smear, which looks for abnormal changes in cervical cells, the HPV test looks directly for the virus responsible for triggering those changes.
HPV is the most common sexually transmitted infection (STI) worldwide, and most sexually active people will be exposed to it at some point in their lives.
The virus includes more than 150 different strains. Around 100 of these strains are responsible for causing warts on areas like the face, hands and feet. Approximately 40 strains specifically affect the anogenital region. Low-risk types are typically associated with genital warts, while high-risk types can cause precancerous changes in the cervix, known as cervical dysplasia, which may progress to cervical cancer over time.
How Does the HPV Test Work?
The process of collecting cells for an HPV test is identical to that of a Pap smear:
- A speculum is gently inserted into the vagina to hold it open.
- A soft brush or swab is used to collect a small sample of cells from the cervix.
- The sample is sent to a lab, but what happens next depends on which test is ordered.
For a Pap smear, the cells are examined under a microscope to identify abnormal or precancerous changes. For an HPV test, the same sample is tested using molecular techniques to detect the DNA or RNA of high-risk HPV strains.
What Happens After The Test?
Once your sample has been analysed, your results are typically available within a few days, depending on the clinic or laboratory.
Results may be:
- Negative: No high-risk HPV types were detected. This means your risk of cervical cancer is low, and the next recommended testing will be in 5 years.
If you haven’t received it yet, getting the HPV vaccine might be a smart choice. This series of injections helps protect against many of the high-risk HPV strains, especially if you haven’t been exposed to them yet.
- Positive: High-risk HPV DNA was found. This doesn’t mean you have cancer, but you may be at increased risk. Depending on the results, your doctor may recommend:
- Earlier or repeat testing of HPV DNA and or Pap test
- A colposcopy, which involves examining the cervix under magnification
- A biopsy, if abnormalities are found during colposcopy
In some countries and clinical settings, HPV self-sampling kits are becoming available. These allow you to collect your own cervical or vaginal cell sample at home using a special swab. While still being studied, self-sampling has shown promising accuracy and may increase screening rates, especially among people who are hesitant to undergo a pelvic exam.
Who Should Get an HPV Test?
HPV testing is recommended for people with a cervix, from the age of 30, to screen for high-risk HPV types that can lead to cervical cancer.
Key Differences Between Pap Smear and HPV Test
Now that we’ve defined the Pap smear and the HPV test individually, let’s take a closer look at how these two important screening tools compare side by side.
Both tests play a vital role in women’s health screening, particularly in the early detection and prevention of cervical cancer. While they’re often performed during the same pelvic exam and use the same cervical cell sample, they serve different purposes and follow different screening timelines.
| Pap Smear | HPV Test | |
| Main Purpose | Detects abnormal or precancerous cells on the cervix. | Detects high-risk HPV types that can cause cervical cancer. |
| What It Screens For | Abnormal cellular changes on the cervix that are cancerous or may become cancerous. | The presence of the virus that may cause cell changes (especially types 16 & 18) |
| Recommended Starting Age | 25 years old | 30 years old |
| Testing Frequency | Every 3 years if results are normal | Every 5 years if results are normal |
| Test Analysis Type | Microscopic examination of cervical cells | Laboratory analysis to detect high risk HPV virus |
| Follow-Up If Abnormal | May lead to further testing, colposcopy or biopsy | May lead to further testing, colposcopy or biopsy |
Always remember that Pap and HPV tests don’t diagnose cancer themselves. Instead, they are screening tools that help your doctor determine if further testing or follow-up care is needed.
Which Test Is Right for You?
That depends on your age, medical history and risk factors. Here’s a general guideline:
- Ages 25-29: You have the option to get a Pap test every three years.
- Ages 30-69: The primary recommendation is to get an HPV test every five years. Alternatively, a Pap test alone every three years can be done.
- Ages 69 onwards: Discuss with your doctor regarding when you can be discharged from cervical cancer screening
You can get a Pap test, an HPV test or both during a routine women’s health screening. Your doctor will recommend the best screening schedule for you based on your age, medical history and any past abnormal results. If you’ve had HPV or unusual Pap results before, you may need more frequent testing.
HPV takes many years to cause abnormal cell changes, and those changes take even longer to turn into cancer. Because HPV tests can detect the virus before it causes any cell changes, they often identify problems earlier than Pap smears do.
Still, both tests are considered highly effective at helping prevent cervical cancer.
Final Thoughts
Cervical cancer is one of the few cancers that can be prevented through routine screening and timely intervention. Both Pap smear and HPV test can detect precancerous cell changes and high-risk HPV types at an early stage, before these issues progress into cancer. This allows for timely interventions that may prevent the disease from developing.
While they differ in purpose—one detecting abnormal cells and the other identifying the virus that can cause those changes—together they provide a more complete picture.
Understanding the roles of each test, their recommended schedules and who should undergo them is key to effective cervical cancer screening.
That’s why here at Prologue Clinic, we believe that regular women’s health screening is a vital part of preventive care. As a dedicated women’s health clinic, we are committed to providing comprehensive, evidence-based screening services in a safe and supportive environment.
- Done by a Female Doctor: Feel at ease knowing your screening is performed by a qualified female physician who prioritises your comfort and dignity.
- Comfort and Privacy: We provide a calm, discreet environment designed to make your experience as smooth and stress-free as possible.
- Comprehensive Care: From consultation to post-screening results, we guide you every step of the way with clear communication and follow-up support.
- Health Screening for Cervical and Breast Cancer: Access essential women’s health services, including Pap smear, HPV testing and breast cancer screening—all in one place.
- Personalised, Respectful Care: We take the time to understand your health needs, answer your questions and provide care tailored to your needs.
Don’t wait for symptoms to appear. Known as the ‘silent cancer,’ cervical cancer often develops silently. Early detection through routine cervical cancer screening not only increases the chances of successful treatment but can also prevent cancer from developing altogether.
If you’re unsure about which test is right for you or when to start, don’t hesitate to speak with one of our healthcare providers. Book an appointment today and take a proactive step toward protecting your future health.
FAQs
Do Pap tests test for HPV?
No, a Pap test does not test for HPV directly. A Pap test checks for abnormal or precancerous changes in the cells of the cervix, which may be caused by HPV, but it doesn’t detect the virus itself.
To identify the presence of high-risk HPV strains, a separate HPV test is required. In some cases, both tests are done together in what’s called co-testing, which offers a more comprehensive cervical cancer screening.
How do I test for HPV?
To test for HPV infection, your doctor will collect a sample of cells from your cervix using a small brush or spatula, similar to how a Pap smear is done. The sample is then sent to a lab to check for high-risk HPV strains that are linked to cervical cancer. The procedure is quick, usually painless and done in a clinic.
Do I still need Pap or HPV tests if I’ve received the HPV vaccine?
Yes. While the HPV vaccine offers strong protection against several high-risk HPV types linked to cervical cancer, it doesn’t cover every strain of the virus. That means regular Pap or HPV testing is still necessary, as recommended by your doctor, to ensure any abnormal changes or infections are detected early.
I’ve had a hysterectomy. Do I still need Pap and HPV tests?
Even if you’ve had a hysterectomy, you might still need Pap and HPV tests. It all depends on the specific type of hysterectomy you underwent and your personal health history. The best course of action is to consult your doctor or nurse to determine your individual screening needs.
– If your cervix was removed during a hysterectomy done for reasons unrelated to cervical cancer or abnormal cells, you likely don’t need Pap or HPV tests anymore.
– However, if the hysterectomy was performed due to cervical cancer or precancer, continued testing is necessary. Your doctor will advise you on how often you should be screened.
– In rare cases, if your uterus was removed but your cervix was left intact, you’ll still need routine Pap and HPV tests until at least age 69—provided you’ve had three consecutive normal Pap tests or two normal HPV tests in the last 10 years, with the most recent one in the past 5 years.
Always consult your healthcare provider to determine the best screening schedule for your specific situation.
Are Pap and HPV tests painful?
Some women may find Pap and HPV tests a bit uncomfortable, but they shouldn’t be painful. You might feel some pressure when the doctor or nurse inserts a speculum.
If you’ve never had sexual intercourse or have experienced discomfort with vaginal insertion in the past, you can ask your provider to use a smaller speculum to make the exam more comfortable.
