From the Research
For a patient with a Pap smear showing high-risk HPV (hrHPV) positive but negative for HPV types 16/18/45, the recommended approach is colposcopy with directed biopsies of any visible lesions, as supported by the most recent study 1. This approach allows for direct visualization of the cervix and targeted sampling of suspicious areas to determine if there are precancerous changes requiring treatment.
- If colposcopy reveals cervical intraepithelial neoplasia (CIN) grade 2 or higher, treatment options include excisional procedures such as loop electrosurgical excision procedure (LEEP) or cold knife conization to remove the affected tissue.
- For lower-grade findings or normal colposcopy, close follow-up with repeat co-testing (Pap and HPV) in 12 months is appropriate rather than immediate treatment, considering the lower risk of progression to cancer with non-16/18/45 types, as indicated by 2. It's essential to note that while types 16/18/45 are associated with higher cancer risk, other hrHPV types, such as HPV 33, can still cause precancerous changes and have a significant correlation with CIN2+ lesions, as found in 1. The management approach balances the risk of progression to cancer against the potential harms of overtreatment, emphasizing the importance of regular follow-up and adjunctive measures like smoking cessation and maintaining a healthy immune system to promote HPV clearance and prevent progression, as suggested by the long-term follow-up results in 2.