From the Guidelines
The recommended follow-up for a patient with an HPV-positive Pap smear is to follow the 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors, which suggests that if a patient has a minimally abnormal test result that was preceded by a negative screening HPV test or cotest within the past 5 years, follow-up in 1 year instead of colposcopy is recommended 1. For patients with HPV-positive results but normal cytology, the guidelines recommend follow-up in 1 year instead of immediate colposcopy, unless the patient is at high risk or has a history of abnormal cytology.
- If cytology shows atypical squamous cells of undetermined significance (ASC-US) or worse, colposcopy is indicated.
- For women with HPV-positive results, referral to colposcopy is recommended if cytology test results are abnormal or the HPV test is positive at the 1-year follow-up visit.
- Treatment can be expedited for high-risk patients, and the decision to treat should be based on patient and provider preferences, as well as the patient's risk factors and medical history 1. The approach balances early detection of precancerous lesions with avoiding unnecessary procedures, as most HPV infections clear spontaneously within 1-2 years.
- The follow-up strategy aims to identify women at higher risk for cervical dysplasia while minimizing interventions for transient infections that pose minimal cancer risk.
- Clinics that serve clients who might have difficulty adhering to follow-up recommendations and for whom linkage to care is unlikely should consider offering in-house colposcopy and biopsy services 1.
From the Research
Follow-up for HPV Positive PAP Smear
- The recommended follow-up for a patient with a Human Papillomavirus (HPV) positive Papanicolaou (PAP) smear involves regular monitoring with HPV DNA testing and cytology 2, 3.
- Studies have shown that HPV DNA testing can detect residual or recurrent disease after treatment of high-grade cervical intraepithelial neoplasia (CIN) with high sensitivity and negative predictive value 3.
- The combination of HPV DNA testing and cytology can provide better specificity and positive predictive value than either test alone 2, 3.
- Follow-up visits should include interview, gynecological examination, cervical cytology, HPV DNA testing, and colposcopy 2, 4.
- Patients with abnormal colposcopy or high-grade squamous intraepithelial lesion (HSIL) smear should undergo new excision procedure, and presence of histologically confirmed CIN 2/3 or higher should be considered as residual or recurrent disease 2.
Timing of Follow-up
- Follow-up visits should be scheduled at 3,6,12,18, and 24 months after treatment 3.
- A Pap smear can significantly predict disease recurrence at the first follow-up visit, while HR-HPV testing shows 100% sensitivity and negative predictive value at the 6-month visit 3.
- Close monitoring is essential for the earlier detection of residual and recurrent disease, especially in patients with high-risk HPV subtypes 4, 5.
Diagnostic Methods
- Colposcopic biopsy results can be used to evaluate the presence of high-grade intraepithelial lesions (HSIL) in patients with normal cervical cytology and high-risk HPV subtypes 5, 6.
- LEEP-conization can be used as a diagnostic and therapeutic method, especially in patients with extensive abnormalities or discrepancies in test results 6.
- HPV genotyping and vaccination can be offered as part of the follow-up and prevention strategy 6.