From the Guidelines
For a patient with a previous HPV-positive Pap test who now tests HPV-negative one year later, the recommended next step is to return to routine screening, typically repeating co-testing (both Pap and HPV testing) in 3 years. This approach is based on the most recent guidelines and evidence, including the recommendations from the American Cancer Society and the American Society for Colposcopy and Cervical Pathology 1. The negative HPV test indicates that the virus is no longer detectable and the risk of developing cervical abnormalities has significantly decreased.
Key Considerations
- The patient's age, previous Pap results, and overall risk factors for cervical cancer should be taken into account when determining the screening schedule 1.
- Persistent HPV infection is what leads to cervical abnormalities and potentially cancer, so regular gynecological care and follow-up are crucial 1.
- The 2014 guidelines from the Journal of the National Comprehensive Cancer Network recommend 3-year follow-up for women with positive ASC-US Pap tests with negative HPV results 1.
Screening Recommendations
- Women ages 21 to 29 years should receive cytology screening every 3 years with either conventional cervical cytology smears or liquid-based cytology 1.
- For women ages 30 to 65 years, the preferred approach is cotesting every 5 years with cytology and HPV testing, or screening every 3 years with cytology alone 1.
- Women should discontinue screening after age 65 years if they have had 3 consecutive negative cytology tests or 2 consecutive negative cotest results within the 10-year period before ceasing screening 1.
Next Steps
- The patient should maintain regular gynecological care and follow their healthcare provider's personalized screening schedule.
- No immediate intervention or treatment is needed since the HPV infection has cleared naturally, which occurs in most cases.
From the Research
Next Steps for HPV Positive PAP and HPV Negative Follow-up
- For a patient with a Human Papillomavirus (HPV) positive Papanicolaou (PAP) test who tests HPV negative one year later, the next steps can be guided by existing research on HPV testing and cervical cancer screening 2, 3, 4, 5, 6.
- A study from 2006 suggests that HPV testing in combination with Pap tests is highly sensitive for detecting cervical intraepithelial neoplasia (CIN) 2/3 and cancer, and that a negative HPV test in combination with a normal Pap test result in women aged 30 and older allows for the safe extension of the interval between cervical screenings 2.
- Another study from 2023 found that a negative HPV cotest result is predictive of the absence of a high-grade squamous intraepithelial lesion (HSIL), and that patients with an unsatisfactory Papanicolaou test and negative HPV cotest may be safely called back at an interval longer than 4 months 3.
- Research from 2015 indicates that women with negative Pap tests and positive HPV co-test results have a higher prevalence and cumulative risk of developing high-grade cervical intraepithelial neoplasia (CIN 2+), and that timely quality assurance review of such cases is valuable 4.
- Studies have also explored the impact of HPV testing on national Pap test volume, with projections suggesting that the total number of Pap tests performed annually will decrease substantially in the future due to HPV testing and vaccination 5, 6.
- Based on these findings, the next steps for a patient with an initial HPV positive PAP test and a subsequent HPV negative result one year later may include:
- Repeat co-testing in 12 months or immediate reflex genotyping for HPV16 or HPV 16/18, as recommended for women with negative Pap tests and positive HPV co-test results 4.
- Extension of the interval between cervical screenings, as a negative HPV test in combination with a normal Pap test result in women aged 30 and older is considered safe 2.
- Consideration of the patient's age, screening history, and other risk factors in determining the appropriate follow-up interval and testing strategy 3, 5, 6.