Background: In a uterine didelphys with two cervices, cervical screening may not reveal the same abnormalities.
Case: We present a patient with a uterine didelphys with two cervices in a single vagina after resection of a longitudinal vaginal septum at age 12. She presented with abnormal Pap test results with the right and left cervices discordant from each other. Despite both cervices sharing stroma in the midline, her right cervix was negative for human papillomavirus (HPV) and dysplasia, while her left cervix was HPV positive with high-grade cervical dysplasia on an excisional specimen.
Conclusion: Uterine didelphys with shared bilateral cervices will not necessarily share the same HPV status or have concordant dysplasia.