After an Abnormal Cervical Smear or Positive HPV Test: What Happens Next
Receiving an abnormal cervical smear result or a positive HPV test provokes understandable anxiety. It is important to put the result in context: an abnormal smear is not a cancer diagnosis, and in most cases, the cells are either mildly abnormal or the HPV will be cleared by the immune system within 12–24 months. The screening and colposcopy pathway exists precisely to intercept genuine cancer risk before it becomes invasive disease.
Colposcopy: What to Expect
Colposcopy is an outpatient examination of the cervix using a magnifying instrument (colposcope). Acetic acid is applied to the cervix, which causes abnormal cells to turn white (acetowhite), and Lugol iodine further delineates the transformation zone. The procedure takes 15–20 minutes, is generally well-tolerated with mild discomfort, and allows the doctor to identify abnormal areas and take targeted biopsies.
A biopsy result takes 1–2 weeks and will confirm whether CIN 1, CIN 2, or CIN 3 is present, or whether the tissue is normal despite the abnormal smear.
LEEP / LLETZ: Treating CIN
Large loop excision of the transformation zone (LLETZ or LEEP) is the most common treatment for high-grade CIN (CIN 2 and CIN 3). A thin wire loop powered by electrical current removes the transformation zone — where most CIN originates — with precise margins. The excised tissue is sent for histology to confirm complete excision. The procedure is performed under local anaesthetic in the outpatient clinic and takes 10–15 minutes. Cure rates exceed 90% with a single treatment.
Follow-Up and Test-of-Cure
After LLETZ, a test-of-cure smear with HPV co-testing is performed at 6 months. A negative HPV result at this point is highly reassuring and allows return to routine screening intervals. HPV persistence after treatment indicates higher risk and warrants continued surveillance with annual co-testing for 3–5 years.
The important message: an abnormal smear with prompt follow-up is a success story. The system is working. Do not avoid colposcopy out of fear.
Dr. Nishtha Tripathi Patel performs colposcopy and LLETZ in Ahmedabad. Contact: +91 76988 00333.