Do Pap Smears Test for STDs?

Cervical smear test equipment
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Question: Do Pap Smears Test for STDs?

When someone asks, "do Pap smears test for STDs?" that may not be their real question. What they might actually want to ask is, "if my Pap smear came back normal, could I have an STD?"

Many women assume that their doctors are testing them for STDs as part of their annual exam. They may also believe any STDs they might have would show up on a Pap smear. However, that is not the case.

Just because you're getting a pelvic exam and a Pap smear does not mean that you are getting thoroughly tested for STDs. STD testing is often done at the same time as a Pap smear. However, those tests require separate samples.

Answer: Not in the way you probably mean...

The most simple answer to the question of what STDs Pap smears test for is, "they don't." But that's not always a completely accurate answer. In general, Pap smear do not test for STDs, and they are not considered STD tests. However, in certain circumstances, a Pap smear may include HPV testing on the sample that is taken from your cervix. That's technically an STD test that's happening, although it's arguable whether or not a doctor would consider that to be part of the Pap smear itself. It is also possible that swelling or damage from other STDs could show up on your Pap smear. However, individuals will not be diagnosed with STDs after getting a Pap smear.

That requires comprehensive STD screening. Pap smears do not test for the diseases that should be screened for regularly in sexually active adults such as:

Pap smears also do not test for other STDs that individuals may be concerned about. Some common STDs where testing varies based on individual risk, are:

Sometimes individuals confuse a wet mount with a Pap smear. A wet mount is a slide made from a swab of your vagina that looks for vaginal infections. Wet mounts can yeast infections and other conditions that can easily be identified visually,such as BV and trichomoniasis. In contrast, a Pap smear is a swab of your cervix that is examined by a doctor in a pathology lab. It's purpose is solely to locate early signs of cervical cancer. Neither a Pap smear or a wet mount will identify most common STDs.

When you're asking "does a Pap smear test for STDs?" are you really asking "should I get an STD test?" If so, the answer is no and yes, respectively.  A Pap smear during a gynecological exam is no substitute for thorough STD testing. If you are sexually active, and not in a long-term mutually monogamous relationship that started with negative tests, you should get screened for STDs on a regular basis.That requires urine tests and blood tests. You can't just hope something will be seen on your Pap. 

Pap Smears and STD Tests - The Controversy over Timing

Pap smear guidelines have changed to make the cervical cancer screening test required less frequently. Therefore this question about the relationship between Pap smears and STD tests is becoming even more important.

If a woman is going to get an STD test it usually does happen at the same time as her Pap. Therefore, fewer woman are getting regularly tested for STDs, because Pap smears are required less frequently. There's a potential for that to cause significant long term problems, Undetected chlamydia (and other) infections can lead to pelvic inflammatory disease and infertility.

It's a different problem for men. They often don't get tested at all unless they're either proactive or symptomatic. Common wisdom states that is because the medical system is much more proactive about protecting women's fertility than it is about sexual health for all.

What can be done? In an ideal world, primary care doctors would offer sexual health screening as part of adults' annual exams. Now that most STD tests don't require physical examinations, the barriers to that have been lowered. Unfortunately, that's unlikely to happen as a matter of routine. Until it does, if you want STD screening, you'll have to ask for it

Sources:
Seña AC, Mertz KJ, Thomas D, Wells D, Costa S, Levine WC. A survey of sexually transmitted diseases/HIV coinfection testing and reporting practices among health care providers in New Jersey. Sex Transm Dis. 2005 Jul;32(7):406-12. 

Ursu A, Sen A, Ruffin M. Impact of Cervical Cancer Screening Guidelines on Screening for Chlamydia. Ann Fam Med. 2015 Jul;13(4):361-3. doi: 10.1370/afm.1811.

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