What are the management and follow-up recommendations for a 33-year-old female with a Human Papillomavirus (HPV) positive status and a negative Papanicolaou (Pap) smear?

From the Guidelines

For a 33-year-old female with HPV positive status and a negative Pap smear, the recommended management is to repeat co-testing (both HPV test and Pap smear) in 12 months, as per the most recent guidelines from the American Cancer Society 1. This approach allows time to monitor whether the HPV infection will clear naturally, which occurs in most cases, especially in younger women. The patient's current age and screening results align with the guidelines for individuals at average risk, which suggest primary HPV testing alone every 5 years, cotesting every 5 years, or cytology alone every 3 years for those aged 25-65 years 1. However, given the patient's HPV positive status, the preferred approach is to follow the guidelines for management of positive results and subsequent surveillance, as outlined in the ASCCP 2020 Risk-Based Management Consensus Guideline, which recommends repeat co-testing in 12 months for women with HPV positive results and negative cytology 1. If the follow-up testing at 12 months shows persistent HPV infection but normal cytology, another co-test should be performed in 12 months. If HPV remains positive after 24 months of surveillance despite normal Pap results, colposcopy is recommended to evaluate for possible lesions not detected by cytology, as suggested by previous guidelines 1. During this monitoring period, no specific medications are needed as most HPV infections resolve spontaneously through the body's immune response. It's essential to counsel the patient that this finding is common and doesn't indicate cancer, but requires appropriate follow-up to monitor for potential progression. Regular follow-up is crucial because persistent high-risk HPV infection is the primary risk factor for developing cervical dysplasia and potentially cervical cancer over time. Additionally, smoking cessation, if applicable, may improve immune response against HPV, and the patient should be advised accordingly. The patient should be informed about the importance of adhering to the recommended follow-up schedule to ensure early detection and treatment of any potential cervical abnormalities. Key points to consider in management include:

• Repeat co-testing in 12 months for HPV positive results and negative cytology
• Consider colposcopy if HPV remains positive after 24 months of surveillance despite normal Pap results
• Counsel the patient on the importance of follow-up and the potential risks associated with persistent HPV infection
• Encourage smoking cessation, if applicable, to improve immune response against HPV.

From the Research

Management and Follow-up Recommendations

• For a 33-year-old female with a Human Papillomavirus (HPV) positive status and a negative Papanicolaou (Pap) smear, the management and follow-up recommendations are as follows:

HPV Testing and Cervical Cancer Screening

• HPV testing is not recommended as part of primary cervical screening for women younger than 30 years of age, as HPV infection is common in young women and most commonly transient 2.
• However, for women aged 30 and older, a negative HPV test in combination with a normal Pap test result allows the safe extension of the interval between cervical screenings 2.

Follow-up for HPV Positive Women

• Women who test positive for high-risk HPV without significant changes on reflex cytology or dysplasia on cervical colposcopy-oriented biopsy are always referred to colposcopy 3.
• A study found that all women testing positive for HPV, regardless of Pap smear result, should be referred to colposcopy 3.

Colposcopy and Biopsy

• Colposcopy and biopsy are recommended for women with mildly abnormal cervical cytologic findings, such as atypia, human papillomavirus (HPV) changes, or mild dysplasia 4.
• Patients with minimal Pap smear abnormalities, such as HPV changes or atypia, are likely to have a worse histologic diagnosis, with approximately two thirds showing dysplasia 4.

Screening and Interpretation

• Papanicolaou smear is recommended for any adolescent who has ever been sexually active or exposed to human papillomavirus or is 18 years of age 5.
• New classification systems for cytological diagnoses and new types of Pap smear preparations, such as the ThinPrep system and computer-assisted automated Pap test screening, may increase the sensitivity of this screening test and reduce the false-negative rate of Pap smears 5.