From the Guidelines
For a 46-year-old female with a normal Pap smear (NILM) but positive HPV test, the recommended next step is to perform colposcopy. This procedure allows for direct visualization of the cervix with magnification and application of acetic acid to identify any abnormal areas that require biopsy. During colposcopy, the physician will take targeted biopsies of any suspicious areas to rule out precancerous or cancerous lesions.
Key Considerations
- The patient's age of 46 is significant because HPV infections at this age are less likely to clear spontaneously compared to younger women, making thorough evaluation important.
- HPV positivity, even with normal cytology, indicates a higher risk for developing cervical dysplasia.
- Persistent high-risk HPV infection is the primary cause of cervical cancer.
Management Approach
- If colposcopy is normal with no concerning findings, the patient should have repeat co-testing (Pap and HPV) in 12 months.
- If HPV remains positive at follow-up testing, continued surveillance or more aggressive management may be needed depending on the specific HPV type and persistence. This recommendation is based on the most recent guidelines, including the 2021 sexually transmitted infections treatment guidelines 1, which emphasize the importance of colposcopy in the management of abnormal cervical cancer screening tests and cancer precursors.
From the Research
Management of 46-year-old Female with NILM on Pap with Positive HPV
- The patient has a positive HPV test result with a NILM (negative for intraepithelial lesion or malignancy) Pap smear result, which requires further management to rule out any potential cervical abnormalities 2.
- According to the study by 2, all women testing positive for HPV, regardless of Pap smear result, should be referred to colposcopy for further evaluation.
- The study by 3 found that less than half of patients with HPV-positive results and NILM cytologic findings received a surveillance cotest during the guideline-recommended time frame, highlighting the need for improved follow-up and management of these patients.
Next Steps in Management
- Colposcopy is recommended as the next step in management for patients with positive HPV test results and NILM Pap smear results 2.
- The patient should be referred to a colposcopist for further evaluation and potential biopsy to rule out any high-grade lesions or cervical cancer.
- The study by 4 compared different screening tools, including Pap smear, visual inspection, and HPV testing, and found that HPV testing was effective in detecting high-grade lesions and cervical cancer.
Importance of Follow-up and Surveillance
- Regular follow-up and surveillance are crucial for patients with positive HPV test results and NILM Pap smear results to ensure early detection and treatment of any potential cervical abnormalities 3.
- The study by 5 found that provider recommendation and patient initiation of Pap testing were important factors in the uptake of cervical cancer screening among young women, highlighting the need for healthcare providers to play an active role in promoting screening and follow-up.