The fear is that some teen girls may misinterpret the new guidelines and miss out on important discu...

1. Will cutting back on teen Pap tests result in more STDs?
The fear is that some teen girls may misinterpret the new guidelines and miss out on important
discussions with a gynecologist.
STORY HIGHLIGHTS
Some worry that STDs, teen pregnancies could go up without Pap tests to prompt doctor's visit
New guidelines say young women can postpone cervical cancer screening until age 21
The guidelines still recommend that girls who are under 21 see a gynecologist
(Health.com) -- Teen girls can skip Pap tests, according to new guidelines that say women should
start cervical cancer screening at age 21. But some experts are concerned that rates of sexually
transmitted diseases or unplanned pregnancies could increase without the Pap test to prompt a
doctor's visit.
As it stands, as many as one in four U.S. teenage girls has had an STD at some point in her life, often
soon after she becomes sexually active, according to research published this week in Pediatrics.
"I am concerned that without the recommendation for young women to get Pap smears early on,
they will lose important opportunities to seek advice and to learn about their health -- particularly
their sexual health -- at a time in their lives when they need it most," says Kimberly Spector, an
adolescent-health educator in Los Angeles, California. "Regardless of the tests performed during a
gynecologist visit, the conversation regarding sexual health risks and preventative measures can be
very informative and empowering for young patients."
In the past, women were told to start Pap tests, which can detect abnormal cells in the cervix, three
years after becoming sexually active or at age 21 -- whichever came first. However, these abnormal
cells often go away on their own, particularly in young women. If they don't, such cells grow so
slowly that catching them at age 21 is still early enough to remove them before they become
cancerous. And catching them sooner could lead to unnecessary tests and treatments that
sometimes damage the cervix, increasing the risk for a premature birth later in life.
Health.com: How to recognize cervical cancer symptoms and other FAQs
Ideally, women need to establish a relationship with a reproductive health provider before they
become sexually active.
--Harold Wiesenfeld, M.D.

2. The new guidelines still recommend that girls who are under 21 see a gynecologist; they just don't
need Pap tests, according to the American College of Obstetricians and Gynecologists. The fear,
however, is that some teens may misinterpret the new rules and miss out on important discussions
about contraception and protection against STDs such as gonorrhea, bacterial vaginosis, chlamydia,
and human papillomavirus.
"If women hear that they no longer need Pap tests annually or until they are 21, perhaps they
wouldn't seek any preventive health care, and whether this results in decreased screening and
identification of chlamydia and other STDs remains to be determined, but it is concerning," says
Harold Wiesenfeld, M.D., the director of the division of reproductive infectious diseases at the
University of Pittsburgh School of Medicine, in Pennsylvania.
Health.com: The most common STDs: HPV, herpes, and chlamydia
Many STDs, including chlamydia and gonorrhea, have no symptoms. "Unless screened, young
women will remain undiagnosed, untreated, and at risk for complications, including pelvic
inflammatory disease, which results in infertility," says Wiesenfeld, who is also an associate
investigator at Magee-Womens Research Institute, in Pittsburgh. "[Still] the Pap test is not the 100
percent trigger to do chlamydia screening," he says. "We need to do a better job about STD
screening overall."
Teens who are sexually active should use contraception and take steps (such as using condoms) to
prevent STDs, even if they don't need Pap tests, says Alina Salganicoff, Ph.D., the vice president and
director of women's health policy for the Henry J. Kaiser Family Foundation, an advocacy group
based in Menlo Park, California.
Health.com: Who's most at risk for STDs?

3. "We are going to have to pay special attention to how we educate our adolescent patients about
contraception and STD prevention," she says.
However, most experts agree that Pap tests are indeed unnecessary for younger women and that the
new guidelines will not put them at risk. Most also agree that the new guidelines are not an effort to
limit care.
"I do not fear the consequences because these guidelines are well thought out and give us a great
opportunity to focus on who is at risk for cervical cancer," says Bobbie Gostout, M.D., the chair of
the department of obstetrics and gynecology at the Mayo Clinic, in Rochester, Minnesota.
"Cervical cancer screening is very important, but we are getting smarter at screening," she says.
"We are backing off from screening those that have less to gain from it." The cervical guidelines,
which recommend that sexually active teens still be counseled and tested for STDs (although a pelvic
exam might not be necessary), "hit it right," she says.
Health.com: How to protect yourself from STDs when your partner may be cheating
Teens who have received human papillomavirus vaccines, such as Gardasil, are protected against
several HPV strains that are linked to many, but not all, cervical cancers and to genital warts. These
types of vaccines may eventually reduce cervical cancer rates even further (rates have been
dropping since the 1970s), although experts say the impact won't be seen for 10 to 15 years.
Therefore, girls and women given the HPV shot need to have Pap tests starting at age 21 and every
two years after that, just like those who haven't had the shot.
The Centers for Disease Control and Prevention has added Gardasil to its routine childhood vaccine
schedule. It recommends that Gardasil, which is administered in three doses, be given to all girls
ages 11 and 12, and even for girls as young as 9, with catch-up doses for girls and women ages 13 to
26 who haven't been vaccinated.
"We know that the HPV types targeted by the new vaccine are linked to cervical cancers that tend to
occur five years earlier than cervical cancers caused by other HPV types," Gostout says. "So once
adolescents are well vaccinated against HPV, we should have even more confidence in eliminating
Pap tests in younger women."
Health.com: 10 questions to ask a new partner
"We are now rolling out the vaccine, and clearly the first group that will experience broader
protection is young women," agrees the Kaiser Family Foundation's Salganicoff. "The HPV vaccine is
a really important step that young women can take in terms of protecting themselves against HPV
and subsequent cervical cancer."
Ideally, teens should have an HPV shot and see a gynecologist for counseling about STDs before they
become sexually active, experts say. HPV vaccines don't protect women who have already been
infected with the virus.
"Ideally, women need to establish a relationship with a reproductive health provider before they
become sexually active," Wiesenfeld says.