From the Guidelines
For a normal Pap test with positive high-risk HPV, the recommended approach is to repeat co-testing (both Pap and HPV test) in 12 months, as persistent HPV infection increases the risk of developing cervical precancer 1. This approach is based on the guidelines for cervical cancer screening, which recommend different surveillance strategies and options based on a woman’s age, screening history, and her choice of screening tests.
- The American Cancer Society (ACS) estimates that cervical cancer incidence and mortality rates have declined since the introduction of the Papanicolaou (Pap) smear in the mid-20th century, and rates continue to decline 1.
- For women aged 30 to 65 years, the preferred approach is cotesting every 5 years with cytology and HPV testing, although it is also acceptable for women to continue to be screened every 3 years with cytology alone 1.
- Women should discontinue screening after age 65 years if they have had 3 consecutive negative cytology tests or 2 consecutive negative cotest results within the 10-year period before ceasing screening, with the most recent test occurring within the last 5 years 1.
- The ACS recommends that women with an HPV-negative ASC-US result should return for screening in 3 years rather than 5 years, consistent with the American Society for Colposcopy and Cervical Pathology recommendation 1. During this monitoring period, no specific medications are needed, but patients should continue regular healthcare visits and avoid smoking, which can increase HPV persistence.
- Patients should understand that this result means they have an HPV infection but no cellular changes yet, and that close follow-up is essential for early detection of any developing abnormalities 1. If both tests are negative at the 12-month follow-up, the patient can return to routine screening (every 3-5 years depending on age and screening method).
- If either test remains abnormal, colposcopy is recommended for direct visualization and possible biopsy of the cervix, balancing the need to identify women at risk for cervical precancer while avoiding unnecessary procedures for those whose HPV infection will likely clear naturally 1.