What Your Pap Smear Results Really Mean (A South African Guide)

Samantha Pieterse
May 22
11 min read

Updated: May 23

You did the right thing, you booked the appointment, got your pap smear done, and now you’ve received the results. Now the problem is, the results are a mix of medical terms and confusing abbreviations. What does ASCUS mean? Is HPV positive a big deal? And what on earth is LSIL?

In this guide, we explain pap smear results in South Africa in plain language. Whether your report says normal, abnormal, or something in between, we’ll help you make sense of it.

If you want to know how a pap smear is done, read our blog here before continuing.

Doctors arms holding pap smear equipment and a knitted uterus.

What Is a Pap Smear and What Does It Test For?

A pap smear (also called a pap test) is a quick, simple procedure that checks the health of your cervix, the lower part of your uterus that connects to the vagina. During the test, we gently collect a few cells from the cervix using a small brush. It takes less than a minute, and most women say it feels more uncomfortable than painful.

So what are we actually looking for?

A pap smear is not a test for cancer, and it’s not meant to check for infections like STIs. What it does do is pick up early changes in your cervical cells. The kind of changes that could become cervical cancer if left untreated over time.

A pap smear is kind of like spotting weeds in a garden. If you catch them early, you can pull them out before they take over. That’s what a pap smear helps us do: spot and deal with abnormal cells before they grow into something more serious.

Does a Pap Smear Test For HPV?

In most cases, your pap smear will also include a test for HPV (human papillomavirus), especially if you're over 30 or have had abnormal results in the past. HPV is the most common cause of cervical cancer, and certain types (like HPV 16 and 18) are considered "high-risk" because they’re more likely to lead to those dangerous cell changes.

Here’s what’s important to know:

HPV is extremely common. Around 80% of people will get it at some point.
In most cases, your immune system clears it up on its own, no treatment needed.
But when HPV sticks around for years, it can cause trouble. That’s why it’s important to test for it

📍In South Africa, HPV testing is increasingly used alongside pap smears for women over 30, or as a follow-up test if your pap smear results are unclear.

When Should You Start Pap Smears?

In South Africa, pap smears are recommended from age 25, or earlier if you have additional risk factors like HIV. Ideally, they should be repeated every 3 years if results are normal, though some women may need or want more frequent checks.

According to the CDC, how often a pap smear is done depends on your age, previous test results, and other risk factors. They say that, in general, women should start pap smear testing at 21, regardless of when they start having sex.

From 21 to 29, pap smears should be done every three years.
For women aged 30 to 65, there are a few options: pap test alone every three years, co-testing (pap and HPV) every five years, or HPV testing alone every five years.
After 65, screening may be discontinued if there is a history of normal pap smears and low risk.

And yes, you can absolutely do a pap smear after having a baby. In fact, many women forget to catch up on their own health while caring for little ones, so when you go for your 6-week follow-up after birth, make sure you get a pap smear done.

Happy and healthy young women who do regular pap smears.

What Does a Normal Pap Smear Result Mean?

A normal pap smear result means the cells collected from your cervix look completely healthy under the microscope. There are no signs of abnormal changes, precancerous lesions, or anything that suggests cervical cancer could be developing. It's the best result and a great reminder that your routine screening is doing exactly what it's meant to do.

If your sample was also tested for HPV (human papillomavirus) and came back negative, even better. That means there's no sign of high-risk HPV types, which are known to cause most cervical cancers (in fact, >95% of cervical cancer is caused by HPV). So not only do your cells look good, but nothing is working to cause cancer in the background, either.

Basically, your cervix is behaving exactly as it should.

So, Your Results Were Normal - When Do You Need Your Next Pap Smear?

This is where guidelines vary a bit depending on your age, HPV status, and whether you’re accessing care in the public or private sector. Here’s the breakdown for South Africa:

If you’re under 30:

HPV testing isn’t routinely done yet, because HPV is so common and often clears on its own in younger people.
If your pap smear is normal, you’ll usually be advised to repeat the test in 3 years.

If you’re over 30:

You may have had co-testing. That means a pap smear plus an HPV test.
If both tests are normal, you’re generally in the clear for up to 5 years, especially if you’re low-risk.

If you're living with HIV:

You’ll need more frequent screening, starting at diagnosis and then every year. This is because women with HIV are at higher risk for persistent HPV infections and cervical abnormalities.

If you use public health services:

South Africa’s government provides three free pap smears in a lifetime, starting at age 30 and repeating every 10 years if all results remain normal.
However, at Mums & Bums, we recommend more frequent screening, especially for sexually active women or those with additional risk factors.

Why Regular Pap Smears Are Still Important, Even After Normal Results

Even if your last result was normal, changes can happen over time, especially with HPV exposure or shifts in immune function. Doing regular pap smears means you’re always ahead of the game.

Plus, we recommend testing sooner if your circumstances change (like a new partner, symptoms such as abnormal bleeding, or past abnormal results).

A Reminder From Mums & Bums About Pap Smears

At Mums & Bums, we follow evidence-based, up-to-date screening guidelines and offer advice based on your history. Screening for cancer is not just a one-size-fits-all approach. If you're not sure when your next pap smear is due, or if you've never had one, contact us for information and to book an appointment.

🗓️ Book your pap smear with us today - it's quick and incredibly important.

Understanding Abnormal Pap Smear Results: HPV, BV, ASCUS, LSIL & More

Getting a pap smear is one thing, but seeing anything other than “normal” on your results can feel unsettling. Remember, an abnormal result doesn’t always mean cancer. In fact, most changes picked up on a pap smear are mild, temporary, and treatable, especially when caught early.

Here’s what some of the most common abnormal results actually mean, and what to expect next.

What Does It Mean If My Pap Smear Is HPV Positive?

First, don’t panic. A positive HPV test means that one of the high-risk strains of human papillomavirus was found, which can sometimes lead to changes in the cells of the cervix. But it doesn’t mean you have cervical cancer.

HPV is incredibly common. In fact, almost everyone who’s ever been sexually active will be exposed to it at some point. It’s usually harmless and goes away on its own, usually within 12 to 24 months without any treatment at all.

A positive HPV result simply means we need to keep a closer eye on your cervix for a little while, just in case those cancerous changes do start to develop.

What we will recommend next depends on your age and pap smear result:

Pap smear is normal, but you’re HPV-positive: you may be asked to repeat the test in 12 months to see if the virus has cleared.
Pap smear shows cell changes, and you're also HPV-positive: we will likely recommend a colposcopy (more on that later).

Either way, the goal is to monitor things and act before anything becomes serious, which is exactly what screening is supposed to be for.

What Does it Mean If My Pap Smear Results Suggest Bacterial Vaginosis?

Bacterial vaginosis, is a common vaginal infection that happens when there’s an imbalance in the normal bacteria that live in the vagina. Usually, healthy bacteria (mostly lactobacilli) keep everything in check. But when that balance is disrupted, like after using harsh soaps, douching, new sexual partners, or even just hormonal changes, other bacteria can overgrow and cause symptoms.

Unlike thrush (caused by yeast), bacterial vaginosis is bacterial and doesn’t usually cause itching or redness. What it can cause is a thin, greyish-white discharge with a fishy smell, especially after sex. Some women notice nothing at all and only find out during a check-up or Pap smear.

BV is not a sexually transmitted infection, but it is more common in sexually active women. It can increase your risk of getting or passing on other infections, and in pregnancy, it’s been linked to complications like preterm labour, so it’s worth treating.

Treatment usually involves a short course of antibiotics, which clears up quickly for most women.

If your pap smear shows inflammation, and you also have symptoms of BV, your provider might recommend treating the bacterial vaginosis first and then repeating the pap smear a little later, once the infection has cleared. This helps ensure the results aren’t being affected by irritation or inflammation.

What Does Atypical Squamous Cells of Undetermined Significance (ASCUS) Mean on a Pap Smear?

ASCUS or Atypical Squamous Cells of Undetermined Significance means your cervical cells look slightly unusual, but whether it’s from something serious or a harmless irritation is unclear.

This can happen for lots of reasons. Mild inflammation, recent intercourse, vaginal infections, or even your menstrual cycle can sometimes affect the appearance of cervical cells. That’s why ASCUS is often considered a borderline or "uncertain" result, and not a cause for immediate worry.

ASCUS is the most common abnormal pap smear finding, especially in younger women. According to studies from the American Society for Colposcopy and Cervical Pathology (ASCCP), most cases of ASCUS clear up on their own, particularly when they’re not associated with high-risk HPV.

If your pap smear results have found ASCUS, we will want to:

Repeat the pap test in 6–12 months, or
Do an HPV test to decide whether further investigation is needed.

In most cases, ASCUS results do not progress to anything serious, but staying on top of follow-up is how we make sure of that.

What Does Low-grade Squamous Intraepithelial Lesion (LSIL) Mean on a Pap Smear?

LSIL, or Low-grade Squamous Intraepithelial Lesion, means that mild changes were found in the cells on your cervix. These changes are most often linked to HPV infection, particularly in younger women, and in many cases, they clear up on their own as your immune system fights off the virus.

LSIL doesn’t mean you have cancer, and it doesn’t mean you’re going to get it. What it does mean is that some abnormal cells were seen, and we’ll need to keep a closer watch.

Depending on your age and HPV status, we may:

Do an HPV test if not done.
Repeat the pap smear in 6–12 months, or
Advise a colposcopy, which is a closer look at the cervix using a special microscope.

LSIL is pretty common, and studies show that in up to 90% of cases, especially in younger women, these changes go away without needing treatment.

What Does High-grade Squamous Intraepithelial Lesion (HSIL) Mean on a Pap Smear?

HSIL, or High-grade Squamous Intraepithelial Lesion, means the changes in your cervical cells are more significant. These are the kinds of changes that are less likely to go away on their own and more likely to turn into precancer if they’re left untreated over time.

Again, this is not a cancer diagnosis, but it is a sign that we need to act sooner rather than later. The goal here is prevention, and HSIL gives us a chance to stop anything serious from developing down the line.

If your results show HSIL, we will usually recommend:

A colposcopy to closely examine the cervix, and
Possibly a biopsy, where a small tissue sample is taken and tested for more detail.

In some cases, treatment might be advised to remove the affected area, usually if the biopsy confirms that the cell changes are unlikely to go away on their own. This is often done with a minor outpatient procedure, where the abnormal cells are removed from the cervix to prevent them from progressing. These procedures are typically quick, done under local anaesthetic, and don’t require a hospital stay.

Catching HSIL early means that with the right follow-up, you can stay healthy and avoid bigger problems in the future. This is exactly why pap smears are so powerful, they find things before they become dangerous.

What Is a Colposcopy?

A colposcopy is a simple, in-office procedure that allows your healthcare provider to take a much closer look at your cervix, vagina, and vulva using a special magnifying device called a colposcope. It doesn’t go inside your body; it stays outside and is basically a set of binoculars that examine the surface of the cervix in detail.

The procedure usually takes around 10 to 20 minutes, and doesn’t require anaesthesia. You’ll lie back just like you would for a pap smear, and your provider will gently insert a speculum to see the cervix. A solution will be applied to the area to highlight any abnormal-looking cells. This might feel a bit cold or sting slightly, but it’s not painful.

If any areas look unusual, your provider might take a tiny sample of tissue (biopsy) for testing. This part can cause brief cramping or discomfort, similar to a strong period pain, but it’s over quickly.

Most women describe the whole experience as a little longer and a bit more uncomfortable than a pap smear, but very manageable.

Colposcopies are commonly done after:

An abnormal pap smear
A positive high-risk HPV result
Or when there’s a need to investigate ongoing symptoms like bleeding after sex

A colposcopy's goal is to get a clearer picture of what’s going on and decide whether any further treatment is needed. It’s a preventative step, and for many women, it is reassuring.

Could a Pap Smear Detect Cancer?

Yes. But more importantly, a pap smear is designed to catch precancerous changes long before they ever become cancer. That’s what makes a pap smear such a powerful tool. It gives us a chance to act early, monitor any changes, and treat them if needed, often before you’d ever feel symptoms or know something was wrong.

In South Africa (and globally), cervical cancer remains one of the leading cancers affecting women, but regular pap smear screening has already made a difference. According to national health data, early detection through screening has contributed to a decline in cervical cancer deaths, particularly when paired with timely follow-up and HPV testing.

If your pap smear shows something concerning, we will walk you through the next steps. Most cervical changes are treatable when caught early, from extra monitoring to simple outpatient treatments.

That’s exactly why pap smears exist, not to scare you, but to protect you.

A doctor and patient hand holding a wooden heart indicating cervical health.

Do I Still Need Pap Smears After Treatment for Abnormal Cervical Cells?

Usually, yes. Even if abnormal cervical cells have been successfully removed, you’ll still need follow-up pap smears or HPV testing. This is because there’s still a slight chance that abnormal cells could return over time, especially if high-risk HPV is still present or if your immune system is under strain.

In some cases, women who’ve had a hysterectomy (removal of the uterus) may still need regular cervical screening too. If the cervix was not removed, pap smears continue as normal. But even with a total hysterectomy, if it was done because of cervical cancer or high-grade changes (like HSIL), you may still need vaginal vault smears to monitor the area where the cervix used to be.

Follow-up schedules vary depending on your personal history, but they usually include:

A pap smear 6–12 months after treatment
An HPV test to check for persistent infection
Possibly annual screenings for a few years before returning to the standard screening interval

This follow-up aims to confirm that no abnormal cells have returned and to give you peace of mind that everything is still on track.

If you’re ever unsure when your next test is due or whether you still need screening after treatment, it’s best to check in with your healthcare provider. At Mums & Bums, we’ll walk you through a follow-up plan that fits your history, age, and risk profile.

Pap Smear Guidelines in South Africa

In South Africa:

Free pap smears are available at public clinics every 10 years for women over 30.
But private screening every 3 years is strongly recommended — especially if you're sexually active, have HIV, or have had HPV before.

At Mums & Bums Clinic in Rooihuiskraal, we offer:

Quick, respectful pap smears
Gentle female-led care
HPV testing and results support
Guidance through follow-ups

🗓️ Book Your Pap Smear Now – We’ll walk you through everything.

Final Thoughts on Pap Smear Results

A pap smear is a small appointment that can make a huge difference. If you’ve had an abnormal result, try not to stress. Most changes are not cancer, and with regular check-ups, you’re doing the best thing you can for your long-term health.

Come in and chat to us, we’re always happy to explain things properly.