To not understand smear tests.

[BooksandCats123]

I’m 43 and have never missed a smear test.
When I was 30 I had a cin 4 result. I had lots of appointments and was told by an oncologist that looking at my result he should be seeing a tumor of some sort but couldn’t.
I had all sorts of scams including an mri. It was decided that I’d have LLETZ procedure to remove cells and a smear test every 12 weeks then 6 months ect.
Over the years I’ve had the LLETZ procedure two more times.
I had a smear test recently and was told that they no longer look at cell changes unless a certain strain of HPV is detected. My result was negative I got my GP to check my notes and they say I was also HPV negative when I had all the issues 13 years ago.
When I raised concerns about this my doctor said that the HPV test 13 years ago must of been wrong, I wouldn’t have cell Changes without being positive and that there is no need to worry.
But I am, if 3-11% of Cervical cancer cases are from women who are negative (got this percentage from Google) how is it picked up on?
TMI but I had sex earlier with my DH and bled afterwards, I am waiting for a gynaecologist appointment (should be soon) because of pain during sex but the bleeding is a new thing.
When I had a scan in the summer it was suggested I might have Endometriosis and like I said the appointment for to confirm that is hopefully soon.
But bleeding and pain is a symptom of cervical cancer, my aunt had it and sadly didn’t survive.
I feel like my life is being put at risk here. Have I got it wrong or does this way of testing worry other women, where could I get a smear that looks at cell changes?

So when we do the test we have to fully visualise your cervix, the whole thing.
we are trained to be able to identify things like cervical polyps etc.
when we ask you the pre screening questions if you answer yes to the question (that we have to ask) ‘do you have any bleeding after sex?bleeding between periods?’ And you answer yes then I would 100% book you in with a doctor to discuss these symptoms.
I always advise patients as well that even if the test comes back negative for HPV you must not ignore any abnormal vaginal bleeding, discharge etc and you should always make GP appt to discuss.
The dormant HPV does not cause cell changes. It’s when it is detectable. Typically you would need to have active HPV for several years before it would cause abnormalities hence the long gap between smears (it’s gone from 3yrs for under 55s to 5 years for everyone in UK since this July).
does that all make sense?
also yes if the virus has caused changes (over a prolonged period) it is highly likely that the test would be negative as it would’ve become dormant again hence why we would 100% explore any abnormal bleeding etc.

Thank you @Chocdown, that’s very clear. And reassuring.

I have a related question. I'm 62 and contracted HPV in my twenties. An abnormal smear result in my thirties led to colposcopy after which I was put on annual smears. HPV was detected a couple of years ago, but then went. It's all been low grade problems, but I'm glad it's being kept an eye on.

Had a smear yesterday and was told if it's HPV negative I will be discharged from the screening programme because of my age. My past history with HPV will be irrelevant.

I'm not sure what I think about that. Can I assume that because the HPV has never evolved into anything nasty yet I can reasonably expect that won't happen over the next few decades?

Edited for typos

If you look on public health England it explains it in a bit more detail but essentially it’s because it typically takes active HPV 10 to 20 years to become cancerous.
Also, anypost menopausal vaginal bleeding should always warrant a visit to doctor as this is a red flag symptom and would prompt urgent further investigation - so just because you aren’t screened anymore for HPV doesn’t mean you should ignore any worries you have x

That all makes sense, Thanks for explaining.

@MarmadukeM & everyone, thank you for answering my question. That all makes sense and is very encouraging.

I’m a bit concerned by the number of posters saying that they don’t need the test because of fidelity. Ladies protect yourselves, don’t rely on your partner to do it for you. You can never guarantee that they haven’t been unfaithful. At the end of the day this is a free, quick, relatively pain free check, done every 5yrs, which could save your life.

Thanks, that's helpful (though tbh a 10-20 year remaining lifespan is very much at the lower end of my personal ambition...)

Ive had warts got one now on my finger.
But i also have my smears last year i found out i have HPV.
Also having a child or warts dont make you immune to HPV.

Sorry that was meant to say as a child. Yeah a few other people have said the same. I should really book a test

No that’s incorrect - you can clear the virus. But in some women it can remain and linger, and be undetectable as it’s at a subclinical level.

I wouldn’t assume anything. Cervical cancer generally affects younger women but vaginal and vulval cancers are usually diagnosed at a later age. From google AI- but is supported by my own previous research:

As of 2026, the average and median ages for the diagnosis of cervical, vaginal, and vulvar cancers are as follows:

• Cervical Cancer: The average and median age at diagnosis is 50 years old. It is most frequently diagnosed in women between the ages of 35 and 44.
• Vaginal Cancer: The average age at diagnosis is approximately 67 to 69 years old. The median age for HPV-associated vaginal cancer is specifically noted as 68 years old.
• Vulvar Cancer: The average age for a diagnosis of invasive vulvar cancer is 70 years old. Median age estimates for vulvar cancer generally range between 68 and 69 years old.

FTR…Vaginal cancer is not fun. 0/5 stars do not recommend

Can anyone clarify whether you would necessarily continue to test positive for HPV if you have cell changes?
I'm imagining a scenario in which the virus reactivates and causes cell changes, but then clears up... in which case you may never test positive for hpv despite potentially developing an hpv related cancer.
Also, does the immune system ever clear the virus completely or does it always remain (whether dormant or active) once you've been infected?

https://my.clevelandclinic.org/health/diseases/11901-hpv-human-papilloma-virus

https://health.clevelandclinic.org/does-hpv-go-away

https://www.mayoclinic.org/tests-procedures/hpv-test/about/pac-20394355#:~:text=A%20positive%20HPV%20test%20doesn,take%20years%20to%20show%20up.

https://www.mdanderson.org/cancerwise/i-have-hpv-now-what.h00-159698334.html

The other question to ask is about reinfection since it is possible that a partner has it.

pmc.ncbi.nlm.nih.gov/articles/PMC4068337/

So the answer is yes and/or no… Clear as mud… but credible sources.

I think one really important thing to keep in mind is to not panic with a positive hpv test.

Do keep an eye out for symptoms; the two big ones are unusual bleeding and/or a watery discharge that smells bad. And keep up on your exams as recommended by your doctor but don’t hesitate to raise a fuss if you think something is wrong.

Sorry one more bu I believe knowledge is power 😁

https://pmc.ncbi.nlm.nih.gov/articles/PMC8785287/

Thank you.

I've had 4 lletz procedures and been told I'm a great candidate at 42 for a hysterectomy, I'm surprised you haven't been told the same.

Op you are right I’m one who will be missed as well with historical issues that were non HPV linked, following if anyone know where to get cells looked at.

@Throughahedgebackwards I am a cervical screening professional. I have also had CIN3 and subsequent treatment.
The cells during routine smears are screened for HPV. If negative then it’s back to routine 5 year screening for all ages now.
if HPV is detected it’s usually followed up in colposcopy and often a follow up repeat smear is done any time from 3 months to a year later depending on the specialist decision.
Using myself as an example, I had a positive HPV and treatment in colp, then my last 2 smears have been negative.
As sample takers we are also trained to recognise that if the patient has any visual abnormalities when we view the cervix such as suspicious masses, we refer to colp straight away under the 2 week rule. We cannot see HPV in practice which is why colp need to see using a special dye that shows the prominence of the HPV cells.
When we take a smear we also ask the patient whether they have any concerns (such as irregular bleeding, bleeding during/after intercourse etc) and whether they are taking any hormones. We also ask roughly where in their cycle they are or last menstrual period dates. This is all relevant and if we had concerns, again we would refer to the appropriate service/professional.
i hope that helps? Happy to answer anyone’s questions if I can.

@hashbrownsandwich thank you. I’m similar to original poster and others who had lletz but no reference to HPV made at that time (could/prob did have…?) so say I didn’t have …. But still had abnormal cells from the % of non HPV related cases would abnormal cells be picked up? I’ve had discharge changes but again wasn’t offered either colp or cell change/smear … did have STD/BV swab and internal scan….

Also looked into private smears and could only find HPV and would pay if the “old” type of smears existed and would pick up that “missing non-HPV % cases of cell changes”

Thank you everyone for explaining a mystery and a lot of stress I’ve been under-
I was on colposcopies every 3 months before and betwixt kids and pleasantly surprised afterwards that everything was suddenly fine. Fastforward to loads of unpleasant symptoms and they’ve found a polyp on ultrasound (because no pap as oart of the investigation).

The appointment is this week coming, but does anyone know if the cervical risks will still be there if I manage to get a hysterectomy?

If you get a total hysterectomy (so with cervix removed) then no, you wouldn't have any other cervical issues..however, it is also possible to have HPV on the skin of the vagina and to have abnormal vaginal cells so some women have to remain under the care of gynae / colposcopy post hysterectomy for monitoring of the vagina. If you have a hysterectomy you should have a vaginal smear approx 6 months after (or whatever the internal is where you live) to check if you'll need any further vaginal screening
Good luck with your appointment

When did you have your LLETZ? Lots of people will have had changes or treatments back when samples either weren't being tested for HPV or not as sensitively as tests can pick up now.