From the Guidelines
ASCUS on a Pap smear with positive HPV means there are slightly abnormal cells in your cervix along with human papillomavirus infection, and according to the most recent guidelines 1, the standard follow-up for this finding is typically a repeat Pap test or immediate colposcopy. ASCUS stands for "Atypical Squamous Cells of Undetermined Significance," which indicates minor cell changes that aren't clearly precancerous but aren't completely normal either. When combined with HPV (especially high-risk types), this finding requires follow-up because HPV can cause these cell changes and potentially lead to cervical cancer over time. This isn't an immunology issue because it's primarily about direct viral infection of cervical cells causing physical changes to those cells, rather than a problem with your immune system itself. While your immune system does play a role in fighting HPV infections (and most people clear the virus naturally), the ASCUS finding is about detecting cellular changes caused by the virus, not measuring immune function. Some key points to consider include:
- The risk of CIN II-positive disease is approximately 20% in women with ASC-US who are positive for other oncogenic HPV types 1
- The NCCN and ASCCP recommend referring women with ASC-US who are positive for HPV high-risk DNA for colposcopy 1
- Colposcopy is recommended if HPV genotyping is positive for types 16 or 18, and it can be considered if it is infeasible for the patient to return for cytology alone 1
- Expedited treatment should be considered for HSIL cytology results, and colposcopy is recommended in all other cases, even if the cytology test is normal 1
From the Research
ASCUS on Pap Test with Positive HPV
- ASCUS (Atypical Squamous Cells of Undetermined Significance) is a result that can appear on a Pap test, indicating that some cells do not look entirely normal, but it's unclear whether they're precancerous or not 2.
- A positive HPV (Human Papillomavirus) test result, in combination with an ASCUS Pap test, can indicate a higher risk of developing cervical cancer or precancerous lesions 3, 4.
- The presence of HPV is a common finding, and most people will have HPV at some point in their lives, but not all types of HPV are associated with an increased risk of cancer 5.
Why ASCUS with Positive HPV is Not an Immunology Issue
- ASCUS with positive HPV is primarily a concern related to cervical cancer screening and prevention, rather than an immunology issue 2, 3.
- The immune system plays a role in fighting off HPV infections, but the management of ASCUS with positive HPV is focused on monitoring and preventing the potential development of cervical cancer, rather than treating an immunological disorder 4, 6.
- The current guidelines for managing ASCUS with positive HPV recommend colposcopy, repeat Pap testing, and/or HPV testing, rather than immunological treatments 2, 3, 5.
Management of ASCUS with Positive HPV
- The management of ASCUS with positive HPV typically involves colposcopy, which is a procedure used to closely examine the cervix for any abnormal cell growth 2, 3.
- Repeat Pap testing and HPV testing may also be recommended to monitor for any changes or development of precancerous lesions 4, 5.
- In some cases, a biopsy may be necessary to determine the presence and severity of any abnormal cell growth 2, 3.