Pap Smear Primer

Recommendations for Positive Women

HIV positive women often need more frequent Pap smears. Remember not to douche (douching is not good for any woman, anyway, see "Douching is Bad for You," September/October 2000), use a tampon, and do not have intercourse 48 hours before an exam. Also, the test cannot be done during your menstrual period. A Pap smear should be done at the time of HIV diagnosis and then again in another six months, and if still normal, annually thereafter. Some women will also be offered anal Pap smears because of an increased incidence of rectal HPV (a long cotton swab is used, not a speculum!). An adequate exam will include an interview with questions about your medical history, including any childhood sexual abuse or sex work, and other questions that seem nosy, but are only asked because these situations are associated with some physical problems and behaviors that health care providers should be paying attention to.

Health care providers conducting a Pap smear should know that a curved brush obtains seven times more samples than a spatula; contamination of the sample with lubricant should be avoided; the Pap is to be collected before a physical examination or samples for STD testing; an ectocervical sample should be obtained before an endocervical sample; clumping or air-drying of the sample should be avoided; and if using spray fixative, the spray should be held at least 10 inches away to prevent disruption of cells by propellant. Nurse practitioner and advocate for positive women Risa Deneberg recommends that health care workers be prepared to address fears women have about disease and provide reassurance. In particular, they should realize that women often take findings of abnormalities to be a diagnosis of cancer. They should discuss potential treatments before results are known, especially if the woman will be referred somewhere else.

Risk Factors

Risk factors for pre-cancerous and cancerous changes in the cervix include smoking. For positive women, having less than 200 T-cells seems to increase risk. One of the most common risk factors, for both positive and negative women, is human papilloma virus (HPV), a very common sexually transmitted infection. HPV also causes genital warts. For more information, visit www.cervicalhealth.org, www.ashastd.org and www.niaid.nih.gov.

Pap Smear Results

• Normal
  Advertisement

• ASCUS (atypical cells of undetermined significance -- it's not known if it's normal or not; usually normal in HIV negative women, but should be followed up with a colposcopy for positive women)

• SIL (squamous intraepithelial lesion), also called dysplasia (abnormal cell tissue); an older term was CIN (for cervical intraepithelial neoplasia)

  • Low-grade SIL (LSIL), or mild dysplasia

  • High-grade SIL (HSIL), or moderate and severe dysplasia; also includes carcinoma in situ, cancer that hasn't spread and can just be taken out

• Invasive cancer

• "Squamous" refers to the thin flat cells of the cervix, "intraepithelial" refers to cells that lie on the surface of tissue