When and why

It is routine for a woman to have a cervical smear (commonly known as a Pap smear) every two years. In women with HIV infection it may be advisable to have this done more frequently. Women with HIV have been shown to have higher rates of sexually transmitted diseases, fungal infections (such as thrush) and menstrual disorders compared with HIV-negative women. A cervical smear should be a part of a regular gynaecologic check-up for all HIV-infected women.

Apart from its use as a routine screening test for abnormal cells, it is also carried out if the cervix looks abnormal on examination or if there has been abnormal bleeding from the vagina.

A speculum is inserted into the vagina and then using a special wooden spatula a sample containing cells from the surface of the cervix is smeared onto a glass slide. After special staining the slide is examined under the microscope to look for abnormal or cancerous cells.

HIV-infected men and women who engage in receptive anal intercourse are also at increased risk of anal cancer. An anal Pap smear every second year may lead to the detection of pre-cancerous cells, and the prevention of anal cancer. However, at present anal Pap smears are not routinely available in most clinics.

How it will help

Regular Pap smears allow for the early detection and treatment of abnormalities in the cervix or the anus such as cancer or early changes which, if left, could develop into cancer.

In HIV there is some evidence that these changes may be more common especially if there is coinfection with the human papilloma virus. If abnormalities of the cervix or anus are detected on a smear then a colposcopy or anoscopy may be carried out. This gives a more accurate assessment of the grade of any abnormalities that are found.