The Pap test and the HPV test are collected at the same appointment using the same cervical swab — but they answer fundamentally different questions and provide complementary information that together create a more complete picture of cervical health than either test alone.
The Pap test asks: Are there abnormal cells visible on the cervix right now? The HPV test asks: Is a high-risk HPV strain present on the cervix? A woman can have a positive HPV test with a normal Pap (HPV is present but has not yet caused visible cellular changes). She can have an abnormal Pap with a negative HPV test (cellular changes present, but not from high-risk HPV). And she can have both tests positive — which is the combination that most significantly increases the probability of high-grade dysplasia being present. Using both tests together (co-testing) provides the most sensitive and specific screening approach and supports the longest safe interval between screening rounds.
The Pap Test (Cervical Cytology) — What It Tests
The Pap test collects cervical cells and examines them under a microscope for abnormal appearance. The pathologist is looking at the actual cells — their shape, size, and nuclear characteristics — to identify changes that suggest dysplasia. The Pap test is a morphologic test: it looks at what the cells look like, not at the presence of a specific virus or marker. Results are reported as NILM (normal), ASCUS, LSIL, HSIL, ASC-H, or AGC. A Pap test can be abnormal without HPV being detected — and it can be normal even when HPV is present because the virus may not yet have caused visible cellular changes.
The HPV Test — What It Tests
The HPV test is a molecular test that detects the DNA or RNA of high-risk HPV strains in the cervical cell sample. It identifies whether specific high-risk HPV types are present — not what the cells look like. Most HPV tests report whether any high-risk HPV is detected, and many specifically identify whether HPV 16 or HPV 18 is present (because these two strains carry the highest cancer risk). The HPV test does not diagnose dysplasia or cancer — it identifies the presence of the viral infection that, if persistent, can cause dysplasia.
Why Co-Testing Is Preferred for Women 30 to 65
When both tests are performed together, the combined result provides more information than either test alone. A co-test that is negative on both Pap and HPV provides the strongest reassurance against cervical cancer development in the near term — so strong that the recommended interval before the next screening is five years. A co-test that is positive on HPV but normal on Pap identifies women who need closer monitoring (one-year repeat or immediate colposcopy for HPV 16/18) before a cellular change would even be visible. This early identification of at-risk women is the key advantage of co-testing over Pap-alone screening.
HPV Primary Screening — An Alternative Approach
Some current guidelines support primary HPV testing — using the HPV test alone as the primary screening tool, without a routine Pap, for women aged 25 and older. When the HPV test is positive on primary screening, a Pap (reflex cytology) is then performed on the same sample. HPV primary screening has equivalent or better sensitivity for high-grade dysplasia compared to co-testing and is becoming more widely adopted. The approach used at your screening visit is discussed at the well-woman exam at Lapeer Women’s Health.
Pap Test Alone for Women Under 30
For women aged 21 to 29, the Pap test is performed alone — without HPV co-testing — every three years. This is because high-risk HPV is extremely common in women under 30 (the majority of sexually active women in this age group will have HPV at some point) and almost always clears without causing lasting dysplasia. Adding HPV testing in this age group would trigger a large number of colposcopy referrals for infections that are virtually certain to resolve, without meaningfully improving outcomes. The Pap alone in this age group effectively identifies the rare cases where significant dysplasia has developed without over-triggering investigation for transient infections.
Guideline-Based Screening Intervals
Cervical cancer screening at Lapeer Women’s Health follows current guidelines: Pap alone every 3 years for ages 21–29; co-testing every 5 years (preferred) or Pap alone every 3 years for ages 30–65. Women with prior abnormal results, high-grade dysplasia treatment, or immunocompromising conditions are screened more frequently based on their specific history.
Result Communication With Context
Every abnormal Pap or HPV result is communicated with a clear explanation of what the result means, what the recommended follow-up is, and why. Results communicated through a patient portal without adequate explanation generate unnecessary anxiety — and at Lapeer Women’s Health, the goal is that you understand your result before you receive it so that you know what to expect.
Complete Follow-Up Pathway
Colposcopy, cervical biopsy, LEEP, and post-treatment surveillance are all available at Lapeer Women’s Health — so your cervical health care from initial screening through any required treatment and subsequent surveillance is managed in one place.
Our team follows current guidelines for Pap and HPV co-testing. No referral required.
Schedule a Gynecologic VisitEducational purposes only. Not medical advice. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.
Gynecologic care for women of every age
Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307
Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.