From the Guidelines
A negative Pap smear with Human Papillomavirus (HPV) negative result, but with normal cytology except for the presence of inflammation, is generally considered to be a low-risk result, and routine follow-up is recommended.
Significance of the Result
- The presence of inflammation may be due to various factors, such as bacterial vaginosis or yeast infection, and should be evaluated and treated accordingly 1.
- A negative HPV test result provides strong reassurance against precancer and cancer, with a low risk of developing cervical cancer in the next 3-5 years 1.
- The American Cancer Society guidelines recommend that women with a negative Pap smear and HPV negative result should be screened every 3-5 years, depending on their age and risk factors 1.
Treatment and Follow-up
- Treatment for the inflammation depends on the underlying cause, such as metronidazole 500mg twice daily for 7 days or clindamycin 300mg twice daily for 7 days for bacterial vaginosis, or fluconazole 150mg as a single dose for yeast infection.
- The patient should be counseled on the importance of regular follow-up and screening for cervical cancer, as well as the risks and benefits of different screening strategies 1.
- It is essential to note that the patient should be advised to avoid sexual intercourse during the treatment period and to use condoms to reduce the risk of transmission of HPV and other sexually transmitted infections.
- The patient should also be encouraged to quit smoking and maintain a healthy lifestyle to reduce the risk of cervical cancer 1.
From the Research
Significance of a Negative Pap Smear with HPV Negative Result and Normal Cytology except for Inflammation
- A negative Pap smear with an HPV negative result indicates a low risk of cervical cancer or precancerous lesions 2, 3.
- The presence of inflammation on a Pap smear does not necessarily indicate an increased risk of cervical cancer, but it may require further evaluation to determine the cause of the inflammation.
- Studies have shown that women with negative HPV tests and normal cytology have a low risk of developing cervical intraepithelial neoplasia grade 3 or worse (CIN3+) 2, 3, 4.
- The risk of CIN3+ is significantly lower in women with negative HPV tests compared to those with positive HPV tests, regardless of cytology results 2, 5.
Screening Intervals for Women with Negative HPV Tests and Normal Cytology
- The American College of Obstetricians and Gynecologists (ACOG) recommends that women with negative HPV tests and normal cytology can be screened every 5 years 3.
- A study found that annual Pap screening for 5 years among HPV-negative women with normal cytology did not detect any cases of CIN2+ and had a significant rate of false-positive abnormal Pap smears 3.
- Another study suggested that the interval between successive smears in cervical cancer screening can be increased considerably for women with cytomorphologically normal and high-risk HPV-negative cervical smears 4.
Management of Women with Negative Pap Smears and HPV Negative Results
- Women with negative Pap smears and HPV negative results can be managed with routine screening according to guidelines 2, 3.
- The presence of inflammation on a Pap smear may require further evaluation to determine the cause of the inflammation, but it does not necessarily require immediate colposcopy or biopsy 6, 5.
- Women with negative HPV tests and normal cytology can be reassured that their risk of cervical cancer is low, and they can follow routine screening guidelines 2, 3, 4.