From the Guidelines
It is recommended to wait for the Pap test results before determining the next steps after a positive HPV test, as HPV testing alone does not provide complete information about cervical health, and management decisions should be based on both HPV and Pap test results, as outlined in the 2019 ASCCP Risk-Based Management Consensus Guidelines 1.
Key Considerations
- A positive HPV test result does not necessarily indicate the presence of precancerous or cancerous cells, and most HPV infections clear on their own without causing cell changes.
- The Pap test is essential in examining cervical cells for abnormal changes that might indicate precancerous or cancerous conditions.
- When both test results are available, healthcare providers can make the most appropriate recommendation based on the patient's specific situation, taking into account the risk of cervical intraepithelial neoplasia (CIN) 3, as suggested by the 2019 ASCCP guidelines 2.
Management Approach
- If the HPV test is positive but the Pap test is normal, repeat testing in 12 months may be recommended instead of immediate colposcopy, as per the guidelines 1.
- However, if both tests show abnormalities, colposcopy may be recommended sooner, especially if the patient has a history of high-grade lesions or if the HPV genotyping is positive for types 16 or 18, which have a higher association with cancer 1.
- The risk-based management framework allows for personalized management recommendations, taking into account patient-level risk data and clinical action thresholds, as outlined in the 2019 ASCCP guidelines 2.
Patient Care
- While waiting for results, patients should continue with their regular healthcare appointments and follow their provider's recommendations once all results are available.
- It is essential to remember that HPV is extremely common, and a positive test does not mean the patient will develop cervical cancer, as most infections clear on their own without causing cell changes 1.
From the Research
Follow-up for Patients with Positive HPV Test Results
- For patients with a positive Human Papillomavirus (HPV) test result, the follow-up approach depends on various factors, including the patient's age, HPV genotype, and cytology results 3, 4.
- The 2019 American Society of Colposcopy and Cervical Pathology management guidelines recommend direct referral for colposcopy for patients 25 years and older who are cotested and HPV positive for the 16 or 18 genotypes 3.
- For patients with high-risk HPV (hrHPV) and normal cytology, guideline-adherent follow-up is lower, with only 47.9% of women receiving biopsies following detection of HPV16/18 with normal cytology, and 30.8% receiving no follow-up within 18 months 4.
Predictive Value of HPV Cotesting
- A negative HPV cotest result in individuals with an unsatisfactory Papanicolaou test (UPT) predicts the lack of high-grade squamous intraepithelial lesion (HSIL) 3.
- The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of concurrent HPV testing at the time of UPT for predicting follow-up HPV test result within 1 year of initial UPT are 80.0%, 94.0%, 71.1%, and 96.2%, respectively 5.
- The mRNA-HPV test has a higher positive predictive value for CIN2-3 in triage of high-risk women and in follow-up of women treated for CIN2/3 6.
Follow-up Intervals
- The American Society of Colposcopy and Cervical Pathology 2019 guidelines recommend repeat testing within 2 to 4 months of an unsatisfactory Papanicolaou test (UPT) result 3, 5.
- However, a study suggests that women with UPT and negative HPV cotest may be safely called back at an interval longer than 4 months 3.
- For patients with HPV-negative low-grade squamous intraepithelial lesion (LSIL) cervical screening test results, repeat cotesting is recommended in 1 year as preferred management 7.