anonymous on August 15, 2011

Could I have an STD even though my Pap smear was normal?

I am sexually active and have been with more than one partner. Four months ago, I had a Pap smear and it came back normal. However, today I got a sports physical and my urine came back with bacteria. Since my last Pap smear, I have been with just one person and I know he hasn’t been with anyone else. Could I have an STD even though my Pap smear was normal? Do Pap smears detect STDs? I have not had any symptoms or problems.

answered by Ruthann M. Cunningham, MD on August 15, 2011

Thanks for your excellent questions. It’s not unusual for people to get confused about the three main types of STD tests – the Pap test, urine tests and blood tests.I’ll do my best to help clear up your concerns.

First, yes, it is possible to have an STD even if your Pap test was normal. Why? A Pap test only looks for HPV – not other common STDs.

Let’s start by talking about the Pap test....actually, a Pap test only looks for one type of STD, namely the type of human papillomavirus (HPV) that causes cervical cancer. When you have a Pap test, your gynecologist takes a sample of cells from your cervix (between your vagina and uterus) and examines at them under a microscope.

If the cells look abnormal, it could mean that you have the kind of HPV that causes cervical cancer. That doesn’t mean you actually have cancer…it just means that you have cells that may be pre-cancerous and, if they’re left unchecked, they could develop into cancer later on.

Typically, if a Pap test comes back positive for this type of HPV, doctors will perform a procedure to remove the cells after which very few women develop cervical cancer.

Now, about urine tests…these tests look for bacteria. Different bacteria can cause many different infections, from sexually transmitted infections like chlamydia, gonorrhea or trichomoniasis to urinary tract infections (UTIs) caused by E. coli.

When you go to the doctor’s office and you’re asked to “pee in a cup,” this is the kind of test that’s being performed. While you didn’t mention what bacteria your urine test identified, the good news is that bacterial infections – including those caused by STDs – can be easily cured with antibiotics.

Your doctor can prescribe the most appropriate treatment for you. I would also encourage your partner to get tested so that he can get treated, too, if necessary...and so that the two of you don’t run the risk of re-infecting each other (especially if you’re not using latex condoms and dental dams during all sexual activity).

Blood tests screen for other STDs…for example syphilis, herpes type 1 (HSV-1), herpes type 2 (HSV-2), HIV, hepatitis B and hepatitis C.

How do blood tests work? Your doctor or a testing facility simply take a sample of your blood to look for antibodies that your body may have produced in response to an infection. Again, if you test positive for an STD with a blood test, a doctor can determine the most effective treatment plan that fits your particular conditions and circumstances.

Keep in mind that many STDs don’t show signs or symptoms…at least not right away. While I’m glad that you’re not experiencing any symptoms or problems, the only way to know your STD status for sure is if you (and your partner) get tested for a full array of common sexually transmitted infections.

Remember, all STDs are treatable and manageable…and some are even curable. If you’re interested in learning more about STD symptoms, risk factors, testing and treatment, see our Expert Guides to STDs.

Bottom line: yes, you could have an STD if your Pap test came back negative. I hope you’ll talk with your doctor to get the tests and treatment you may need in order to protect your sexual health, and that of your partner.

Related Info:

Ruthann M. Cunningham, MD

Dr. Cunningham is a member of the Analyte Physicans Group. She's also a member of the American College of Emergency Physicians, practicing at both Northwestern Lake Forest Hospital in Illinois and at Wheaton Franciscan All Saints Medical Center in Wisconsin. An ER physician since 2000, she regularly treats patients with STDs. Dr. Cunningham was educated at Wayne State University School of Medicine and completed her Emergency Medicine residency at Cook County Hospital in Chicago, IL.

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