From the Guidelines
For a patient with a positive Human Papillomavirus (HPV) result on a Papanicolaou (Pap) smear, the recommended follow-up depends on the presence of abnormal cells and the patient's age, with colposcopy being the preferred next step for those with abnormal cells or high-risk HPV types, as per the 2019 ASCCP Risk-Based Management Consensus Guidelines 1.
Key Considerations
- The management of abnormal cervical cancer screening tests and cancer precursors is guided by the 2019 ASCCP Risk-Based Management Consensus Guidelines, which emphasize a risk-based approach to determine the need for colposcopy or expedited treatment 1.
- For patients with a positive HPV result and normal cells (NILM), repeat testing in 12 months is recommended to assess the persistence of the infection 1.
- The presence of abnormal cells, such as ASC-US or LSIL, in conjunction with a positive HPV result, warrants a colposcopy to further evaluate the cervical tissue 1.
- For women over 30 with certain abnormal results, such as ASC-US with HPV positive, immediate colposcopy is typically recommended 1.
- HPV testing is generally not recommended for women under 25, as HPV infections are common and usually clear on their own in this age group 1.
Importance of Follow-Up
- Persistent high-risk HPV infections can lead to cervical precancer and cancer over time, emphasizing the importance of adhering to recommended follow-up tests 1.
- Most HPV infections clear on their own within 1-2 years without causing problems, and when caught early, cervical precancer is highly treatable 1.
- It is essential to discuss specific results and recommendations with a healthcare provider, as they can provide personalized guidance based on the patient's complete health history 1.
Recent Guidelines
- The 2019 ASCCP Risk-Based Management Consensus Guidelines provide a framework for managing abnormal cervical cancer screening tests and cancer precursors, taking into account patient-level risk data and clinical action thresholds 1.
- These guidelines recommend colposcopy for patients at high risk and allow for the deferral of colposcopy for those at low risk, with follow-up testing in 1 year instead of colposcopy for patients with minimally abnormal test results 1.
From the Research
Recommendations for Patients with Positive HPV Results
- A patient with a positive Human Papillomavirus (HPV) result on a Papanicolaou (Pap) smear should be referred to colposcopy, regardless of the Pap smear result 2.
- The risk of cervical intraepithelial neoplasia (CIN) 3/high-grade squamous intraepithelial lesion (HSIL) is increased in women with a positive hrHPV co-test, with a risk of 22.4% for women with Pap II-p (ASC-US) and a positive hrHPV co-test, and 83.8% for women with Pap IVa-p (HSIL) and a positive hrHPV co-test 3.
- A positive hrHPV test increases the risk for HSIL+ fivefold, and colposcopy is necessary to diagnose HSIL+ correctly 3.
Follow-up and Monitoring
- Women who test positive for HPV should be monitored with repeat HPV testing and cytology, as the risk of developing high-grade CIN is increased in these women 4.
- High-risk HPV testing can be used to monitor patients treated for high-grade CIN, with a sensitivity of 100% and negative predictive value (NPV) at the 6-month visit 4.
- The combination of Pap smear and HR-HPV testing offers clear advantages over single cytology when monitoring women treated for high-grade CIN, with 82% sensitivity, 76% specificity, and 95% NPV 4.
Reflex HPV-DNA Testing
- Reflex human papillomavirus (HPV)-DNA testing may be useful in evaluating women with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H), as a negative HR-HPV result is an excellent predictor of the absence of HSIL 5.
- HPV-DNA testing may serve as a means to better select which patients with ASC-H on Pap smear should undergo colposcopic examination, potentially reducing medical costs and eliminating the need for routine colposcopic examination among patients with ASC-H Pap smears 5.