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 (HPV).

“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, MD, the director of the division of reproductive infectious diseases at the University of Pittsburgh School of Medicine.

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 Dr. Wiesenfeld, who is also an associate investigator at Magee-Womens Research Institute, in Pittsburgh. “[Still] the Pap test is not the 100% 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, PhD, the vice president and director of women’s health policy for the Henry J. Kaiser Family Foundation, an advocacy group based in Menlo Park, Calif.

“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, MD, the chair of the department of obstetrics and gynecology at the Mayo Clinic, in Rochester, Minn.

“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.

Teens who have received HPV 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.

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