Smear (smir) test and genital wart – condyloma

The smear test is a screening test performed to detect malignant (malignant) or potentially malignant (premalignant) changes of the cervix. Since the 1940s, the death rate for women with cervical cancer has decreased by 70 percent. The most important reason for this is that most women are screened with the ‘PAP smear test’.

This test does not make a definitive diagnosis, but it guides us, if an abnormality is found as a result of the test, it is necessary to carry out high-level investigations (biopsy, colposcopy, conization, etc.).

Reception Method:


The test is based on taking secretions from the cervix with the help of a special brush or wooden stick during the gynecological examination. It is definitely not a surgical procedure. An application that does not harm the tissue and does not cause pain. The secretion, which is the swab material, is spread on a thin glass called a slide and sent to the pathologist. The glass, which undergoes staining processes in the pathology laboratory, is examined and evaluated under a microscope. Human Papilloma Virus (HPV) determination is also made with thin smear technique.

In the evaluation, the classification method based on five classes, one of which is classical and old, called Class 1, 2, 3, 4 and 5, and the other is the new method called the Bethesda system. The aim is to identify normal cells, atypical cells, or intermediate cells and provide advice for further investigation or follow-up.


Koilocytic changes in Pap smear suggest the presence of HPV infection and are stimulatory cells for HPV. The presence of koilocyte cells in the smear test requires colposcopic evaluation of the cervix, vagina, vulva and anus (breech) for HPV lesions. Koilocytosis and HPV are frequently encountered in the smear test as ASCUS, LSIL and CIN 1.

Points to be considered

Not having sexual intercourse for 24 hours before the smear is taken helps the results to be more reliable.

Before the smear is taken, no vaginal creams or drugs should be used, and a vaginal douche should not be used for at least 72 hours.

The ideal time for testing is 10 days after the last menstrual period.
In the presence of bleeding, a smear can be taken if it is not in large quantities, such as menstrual bleeding.
One of the important points is that the pathologist who will evaluate the smear is especially experienced in this regard.
How is the reliability?

The false negative rate in smear scanning is approximately 25%. In other words, the probability that the smear will be normal even though it is clinically malignant is 25%. Many factors play a role here, from errors in the technique of taking the smear to the experience of the pathologist.

The importance of the smear test
Generally, the transition of normal cervical cells to cancer cells is not sudden. Pre-cancerous diseases, which are asymptomatic and called pre-malignant, are noticed in this period in those who have a Pap test annually. Treatment of pre-cancerous diseases is very easy and very successful. The patient is recognized without a cancer diagnosis and is treated without requiring major treatment procedures. He will also be cured of an upcoming cancer. It is rare to come across Cervical Cancer (Cervical Cancer) in civilized countries that can have the Pap Smear Test done once a year and deliver this application to the entire population.

Frequency of Doing
It is applied once a year to women who are considered normal, have no complaints and have had normal Pap smear tests. In case of doubtful results, if there is no need for further examination, it can be done at more frequent intervals. Reporting a normal Pap smear test does not prove that the patient’s genitalia is normal. It does not screen for upper uterine and ovarian cancers.
In addition, it is important to perform a gynecological examination, to undergo a sonographic examination for the evaluation of the upper part of the uterus and ovaries, in terms of annual control.

Koilocytic changes in Pap smear suggest the presence of HPV infection and are stimulatory cells for HPV. It can also be found during the routine “pap smear” test in women who do not have any HPV or genital wart complaints, or it can occur in the smear of women with HPV who are under follow-up. About 100 types of HPV virus have been identified and 20 of them have been shown to cause genital tract infections. HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 and 68 are higher in cancer and are high-risk HPV types. More than 90% of condylomas contain HPV DNA.

There is no consensus yet on the necessity of virus typing in smear test evaluation and treatment planning, but in recent years, the number of physicians who believe that HPV _DNA test or “HPV Test” should be performed in suspicious cases has been increasing.

In the smear test, the presence of koilocytosis, with or without atypia of koilocyte cells, requires colposcopic evaluation of the cervix, vagina, vulva and anus (breech) for HPV lesions and necessary treatment. Koilocytosis and HPV are often associated with ASCUS, LSIL and CIN 1 and are evaluated as such. Rarely, although koilocytosis, that is, koilocyte cells are seen in the smear test, the results may not be evaluated as ASCUS, LSIL and CIN 1, since no other atypia accompanies them. However, it should not be forgotten that the presence of “koilocytosis” is a stimulant and requires a good examination and, if necessary, treatment.

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