From the Guidelines
For a 31-year-old female with ASCUS (Atypical Squamous Cells of Undetermined Significance) Pap smear and positive HPV test, the recommended next step is immediate colposcopy with possible biopsy, as the risk of HSIL and cancer is estimated to be around 18% 1. This procedure allows for direct visualization of the cervix using a special microscope and application of acetic acid and iodine solution to identify abnormal areas that may require biopsy. The colposcopy should be scheduled within 4-6 weeks. No specific medication is needed beforehand, though avoiding vaginal medications, sexual intercourse, and tampons for 24-48 hours before the procedure is advised. The procedure takes about 15-20 minutes and may cause mild cramping. Some key points to consider include:
- The presence of HPV (especially high-risk types) increases the risk of developing cervical dysplasia or cancer 1.
- Most HPV infections clear naturally within 1-2 years, but persistent infection with high-risk types can lead to cellular changes that may progress to cancer if left untreated.
- The American Society for Colposcopy and Cervical Pathology (ASCCP) recommends colposcopy for women with ASCUS who are HPV positive, as the risk of CIN 2 or more serious abnormality is significant 1. If the colposcopy and any biopsies show no high-grade lesions, follow-up would typically involve repeat co-testing (Pap and HPV) in 12 months. However, if high-grade lesions are found, further treatment such as loop electrosurgical excision procedure (LEEP) or cone biopsy may be necessary. It's essential to note that while ASCUS itself is a minor abnormality, the presence of HPV increases the risk of developing cervical dysplasia or cancer, and prompt evaluation and management are crucial to prevent progression to more severe disease.
From the Research
Next Steps for a 31-Year-Old Female with ASCUS and HPV Positive
- The patient should undergo further evaluation to determine the presence of cervical intraepithelial neoplasia (CIN) grade 2 or 3, as the risk of developing CIN2+ is higher in women with HPV16 positivity 2, 3.
- Colposcopy is a recommended next step, as it allows for a detailed examination of the cervix and can help identify any abnormal areas that may require biopsy 3, 4.
- The patient may also undergo a loop electrosurgical excision procedure (LEEP) if the colposcopy results are abnormal, as this can help diagnose and treat any precancerous lesions 2, 5.
- HPV testing may be used as a follow-up measure to monitor the patient's condition and determine the risk of developing CIN2+ 2, 5.
- The use of local estrogen therapy may be considered in post-menopausal women with ASCUS and HPV positive results, as it may increase the specificity of the HPV test 5.
- Repeat Pap smear, HPV DNA testing, or colposcopy may be used as triage methods for women with ASCUS and LSIL Pap smear reports, but colposcopy is recommended as the most effective method for detecting high-grade cervical precancerous lesions 6.
Considerations for HPV Positive Results
- Women with HPV16 positivity have a higher risk of developing CIN2+ compared to those with other carcinogenic HPV types 2, 3.
- The risk of developing CIN2+ is also higher in women with ASCUS and HPV positive results, particularly in those with HPV16 positivity 3, 4.
- HPV testing may be used to identify women at risk of developing CIN2+, and those with positive results should undergo further evaluation and monitoring 2, 5.