What’s the Difference Between a Pap Test and STI Testing?

In a nutshell, a pap test (pap smear) does not automatically include testing for sexually transmitted infections (STIs), including HPV. A pap test screens for precancerous cells of your cervix, which is caused by the human papillomavirus (HPV). Your clinician may order a test for HPV, chlamydia or gonorrhea from the pap smear sample at the time of a speculum exam.

While it’s most important to talk with your provider about what kind of testing you need and what testing you are getting, it helps to understand the difference between pap tests and STI testing and why you may need them.

The biggest difference to note is that a pap test screens for precancerous cells in your cervix caused by HPV. During a pap test, the doctor uses a speculum to widen the vagina, then swabs the outside and inside of the cervix to collect a sample of cervical cells. The sample is examined for precancerous cells, i.e. cells that show any abnormalities or changes that could lead to cervical cancer if left untreated.

The main cause of cervical cancer is untreated HPV, a common STI. However, a pap test on its own does not indicate whether or not you have HPV. This requires further and separate testing, which may or may not be done at the same time as the pap test.

For example, if your pap test comes back with unclear or abnormal results, your doctor may recommend an HPV test to determine if this was the cause. Dr. Mary Jacobson, Alpha’s Chief Medical Officer, explains more about the pap test and its results here. While researchers are developing at-home methods, right now a pap test usually requires a doctor’s visit.

Chlamydia and gonorrhea, two of the most common STIs in the United States, can be tested with a urine sample or genital swab. Other STIs like syphilis and human immunodeficiency virus (HIV) require a blood sample. Herpes may require a swab from the herpes sore or a blood test.

Both pap tests and STIs require regular screening, but when and how often you should get tested depends on different factors like age, sexual history, medical history, and prior pap test results.

When should you get a pap test? All women over 21 should get tested regularly, but “regular” is relative. It depends on the results of your previous test and whether you have risk factors for cervical cancer.

Women 21 to 29 years old with no other risk factors can get a pap smear test every 3 years, according to the Centers for Disease Control (CDC). Women under 30 years of age do not need to be screened for HPV. For women 30 to 65 years old, talk to your doctor about whether you should do a pap test or a pap with an HPV test, and how often you should get them. If you have HIV, another immune system disease or existing precancerous cervical cells indicated by your last pap test, you may need to get tested more often.

If you’re sexually active, regular STI testing is key. The CDC recommends that all adults get tested for HIV and hepatitis C at least once. Pregnant women should get tested for syphilis and HIV and all sexually active women under 25 should get tested annually for chlamydia and gonorrhea.

Regardless of age, if you have multiple partners, start a new relationship or have unprotected sex, you and your partner should get tested so you can detect and treat any STIs before they worsen.

You should also get tested if you notice symptoms such as itching or burning sensations around your genitals, spots or sores in the area, discolored or smelly vaginal discharge, pain while you pee, or pain during sex.

Be sure to speak with your doctor to discuss testing if you notice any of the symptoms above. Symptoms of STIs are often mild or undetectable, and can even be caused by other factors. The only way to know for sure if you have an STI is to get tested.

For both pre cervical cancerous changes caused by HPV and other STIs, regular testing ensures early detection so that you can get treated before the symptoms worsen or spread. Getting a pap test is a proactive move as it detects precancerous cells and lets you treat them before they develop into full-blown cancer.

Untreated STIs can also cause future complications such as an increased risk of giving or getting HIV, long-term pelvic pain, fertility issues, or pregnancy complications. Some STIs like chlamydia and syphilis can also be passed on to your baby.

STI testing not only prevents complications for yourself, but also protects you and your current or future partners. If you get tested regularly, you can detect and treat the STI and avoid passing it on to someone else.

It’s impossible to know everything about pap tests and STIs, so talk to your doctor about any concerns or questions you have. Ask about testing, or request specific tests if you feel you need them. It’s empowering to know what conditions you might have so that you can take the necessary next steps.

Alpha’s care team can help you figure out that next step. Complete a visit for STI testing, and your Alpha provider can help you decide which STIs tests to order. You can choose a lab that's convenient for you. Alpha members also get access to medical counseling for cervical cancer screening, HIV, and other STIs. We’re here to provide all the resources you need to take care of your sexual health.