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Abnormal smear results, HPV testing, colposcopy and what happens next.

Most abnormal results are not cancer. The NHS pathway is designed to catch and treat pre-cancer long before it becomes invasive.

Jump to treatment
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Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against NHS Cervical Screening Programme, BSCCP and NICE sources you can see at the end.

  • 03

    Current for 2026

    Reflects HPV primary screening, reflex cytology and modern colposcopy pathways used across the UK.

Key facts

Abnormal smear results at a glance.

The essentials, in plain English - the HPV primary pathway, what each result means and how the NHS acts on it.

  • What it is

    An abnormal result from a routine cervical smear taken through the NHS Cervical Screening Programme, most often flagged by HPV detection.

  • HPV primary screening

    Every sample is tested for high-risk HPV first. Cytology is only examined if HPV is detected, called reflex cytology.

  • HPV-negative

    Routine recall in 3 to 5 years depending on age. Cervical cancer risk is very low without a high-risk HPV infection.

  • HPV-positive, cytology normal

    Early recall at 12 months to see whether the infection has cleared. Most do clear naturally.

  • HPV-positive with LSIL or HSIL

    Direct referral to colposcopy for a magnified examination and, if needed, a biopsy.

  • Highest risk strains

    HPV 16 and 18 cause around 70 per cent of cervical cancers. Gardasil 9 covers these and seven other strains.

Why this guide matters

A screening test, not a diagnosis.

Cervical screening is designed to find changes early, when they are easy to treat. The three points below shape everything else on this page.

  • HPV is the driver

    Persistent high-risk HPV, especially types 16 and 18, causes almost every cervical cancer. Testing for it first is why the pathway works.

  • Cell change is not cancer

    CIN1, CIN2 and CIN3 describe pre-cancerous changes graded by depth. Treating high-grade change prevents cancer developing.

  • One-visit treatment is usual

    LLETZ under local anaesthetic cures around 90 per cent of high-grade lesions in a single visit, with a follow-up smear at 6 months.

How the pathway works

From smear letter to test of cure.

The steps the NHS Cervical Screening Programme follows, in order - so you know what to expect and why.

  1. 01

    Screening

    HPV primary test

    The sample from your smear is tested first for high-risk HPV. This is a molecular test with excellent sensitivity for pre-cancer.

  2. 02

    Screening

    Reflex cytology

    If HPV is detected, the same sample is examined under a microscope for cell changes graded as borderline, LSIL or HSIL.

  3. 03

    Screening

    Result letter and recall plan

    You are written to with a plain-English explanation of the finding, the next step and the timeframe. Ask your GP if anything is unclear.

  4. 04

    Colposcopy

    Colposcopy appointment

    For HPV-positive cytology showing dyskaryosis, you are seen in a colposcopy clinic within a few weeks for a magnified view of the cervix.

  5. 05

    Colposcopy

    Punch biopsy if needed

    Small tissue samples are taken from any abnormal-looking area and graded as CIN1, CIN2 or CIN3 by a pathologist.

  6. 06

    Treatment

    LLETZ or cone biopsy

    If high-grade disease is confirmed, treatment is usually a large loop excision (LLETZ) under local anaesthetic, or occasionally a cone biopsy.

  7. 07

    Treatment

    Test of cure at 6 months

    A repeat HPV test 6 months after treatment confirms clearance. A negative result returns you to routine recall.

Typical timeline: letter to colposcopy in weeks, with test of cure at six months after treatment.

Results explained

What each result actually means.

The categories reported by the NHS Cervical Screening Programme and what happens next for each - from HPV alone through to high-grade change.

  • HPV detected only

    No cell changes seen. Repeat smear in 12 months to check if the infection has cleared naturally, which most do.

  • Borderline changes

    Mild atypia on cytology with HPV present. Colposcopy is usually offered to look more closely at the cervix.

  • Low-grade dyskaryosis (LSIL)

    Minor cell changes that often reflect an active HPV infection rather than pre-cancer. Colposcopy assesses extent.

  • High-grade dyskaryosis (HSIL)

    More marked cell changes with a real risk of underlying CIN2 or CIN3. Prompt colposcopy and biopsy are needed.

  • CIN1

    Mild pre-cancerous change confined to the lower third of the epithelium. Often watched, as many regress without treatment.

  • CIN2 and CIN3

    Moderate and severe pre-cancer. Treatment with LLETZ is usually recommended to prevent progression to cancer.

  • Glandular abnormality

    Less common but important. Refers to changes in the glandular cells and needs urgent colposcopy with a gynae-oncology view.

  • Red flag - visible lesion or bleeding

    A visible cervical lesion, postcoital bleeding or persistent discharge needs urgent gynaecology review, regardless of the smear result.

Treatment

How abnormal smears are managed in the UK.

Monitoring for low-risk results, colposcopy for cell change, LLETZ or cone biopsy for confirmed high-grade disease - and vaccination as prevention.

  • 12-month HPV recall

    For HPV-positive but cytology-normal results, the infection often clears on its own. A repeat smear at 12 months confirms this.

  • Colposcopy

    A specialist examines the cervix with a colposcope after applying acetic acid and iodine. Painless and takes around 15 minutes.

  • Punch biopsy

    A tiny sample of tissue is taken from any abnormal area to grade the change as CIN1, CIN2 or CIN3.

  • See-and-treat LLETZ

    Large loop excision of the transformation zone under local anaesthetic. Removes the abnormal area in one visit for confirmed HSIL.

  • Cone biopsy

    A larger, cone-shaped sample removed under general anaesthetic. Used for glandular disease or when the transformation zone is deep.

  • Watchful waiting for CIN1

    Many CIN1 lesions regress. A repeat colposcopy in 12 months is often preferred to immediate treatment.

  • HPV vaccination (Gardasil 9)

    Prevention rather than treatment. Covers HPV 6, 11, 16, 18, 31, 33, 45, 52 and 58, including the strains causing most cervical cancer.

  • Test of cure

    A single HPV test 6 months after LLETZ. Negative means back to routine recall. Positive means further colposcopy.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, screening service or gynaecologist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NHS Cervical Screening Programme. HPV primary screening pathway and colposcopy referral criteria.

  • BSCCP (British Society for Colposcopy and Cervical Pathology). Colposcopy and Programme Management standards.

  • NICE. Guidance on cervical screening, HPV testing and treatment of cervical intraepithelial neoplasia.

  • Public Health England / UKHSA. HPV vaccination programme information and Gardasil 9 schedule.

Red flags

When to seek urgent review.

Most abnormal smears are managed calmly through the screening programme. These are the situations that need faster action.

  • Postcoital bleeding

    Bleeding after sex, especially if new or persistent, needs urgent gynaecology assessment - do not wait for the next smear.

  • Intermenstrual bleeding

    Bleeding between periods with an abnormal smear result should always be investigated, ideally within two weeks.

  • Persistent HPV positivity

    HPV that stays positive across several years, even with normal cytology, is a real risk factor and needs closer follow-up.

  • Glandular cell abnormality

    Reported as ACG or AIS. Requires urgent colposcopy and gynae-oncology input as it carries a higher risk of hidden cancer.

  • Visible cervical lesion

    Any visible ulcer, mass or friable area on the cervix needs an urgent two-week wait referral, whatever the smear shows.

  • Bleeding after menopause

    Postmenopausal bleeding is a red flag for endometrial and cervical cancer and always warrants urgent gynaecology review.

  • Symptoms in a never-screened person

    Anyone with symptoms who has never been screened, or who has missed several recalls, deserves prompt assessment.

  • Immunocompromised patients

    Reduced immunity, HIV or organ transplant means HPV clears less easily and screening intervals are shorter.

  • Pregnancy with an abnormal result

    Colposcopy in pregnancy is safe. Treatment is usually deferred to after delivery unless invasive disease is suspected.

Living with it

A manageable pathway, with excellent outcomes.

Four things that make the biggest difference day to day - attending appointments, keeping perspective, planning recovery and taking prevention seriously.

A quiet reminder

Screening is one of the best things you can do for your future health.

An abnormal result is the programme doing exactly what it is designed to do - catching change early, when it is easy to treat.

  1. 01 Attend

    Keep every appointment

    Screening only works when it happens. Book your recall, attend colposcopy, and do the 6-month test of cure if you have treatment.

  2. 02 Perspective

    Most abnormal results are not cancer

    HPV is a common virus. An abnormal result usually means monitoring or a minor procedure, not a cancer diagnosis.

  3. 03 Recovery

    After LLETZ, take it easy for a month

    Expect some discharge and light bleeding for up to four weeks. Avoid tampons, swimming and sex during that time.

  4. 04 Prevent

    HPV vaccination still helps adults

    Even after an abnormal result, Gardasil 9 protects against strains you have not yet been exposed to and reduces recurrence risk.

Frequently asked

Everything we get asked about abnormal smears.

Quick answers on HPV, colposcopy, CIN grading, LLETZ and adult HPV vaccination.

  • What does an abnormal smear result actually mean?

    It usually means high-risk HPV was detected on your sample, and sometimes that cell changes were also seen. Most abnormal results reflect an HPV infection or minor cell changes rather than cancer, and the pathway is designed to catch and treat pre-cancer long before it becomes invasive.

  • What happens if I am HPV-positive but my cells look normal?

    You will be invited back for a repeat smear in 12 months. Most HPV infections clear on their own within 1 to 2 years. If HPV is still there at the repeat test, you will be offered colposcopy to have a closer look at the cervix.

  • What is colposcopy like?

    Colposcopy is an outpatient examination that takes around 15 minutes. A speculum is inserted as for a smear, then a colposcope, which is a magnifying camera, examines the cervix from outside. Acetic acid and iodine are painted on to highlight abnormal areas. A small biopsy may be taken and can cause a brief pinch.

  • What do CIN1, CIN2 and CIN3 mean?

    CIN stands for cervical intraepithelial neoplasia and grades how deeply abnormal cells extend into the surface layer of the cervix. CIN1 is mild and often regresses on its own. CIN2 is moderate and CIN3 is severe. CIN2 and CIN3 are usually treated because they can progress to cancer if left untreated.

  • What is LLETZ treatment?

    LLETZ, or large loop excision of the transformation zone, uses a heated wire loop under local anaesthetic to remove the area of the cervix containing the abnormal cells. It takes around 15 minutes, is done in the colposcopy clinic and cures around 90 per cent of high-grade lesions in a single visit.

  • Should I have the HPV vaccine as an adult?

    Gardasil 9 is offered on the NHS to girls and boys aged 12 to 13 and up to age 25 for those who missed it. Adults can pay privately, and it can still be worthwhile after 25, particularly if you have not been exposed to all nine covered strains. It reduces the risk of new infections and recurrent disease after treatment.

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