Screening Recommendation for 24-Year-Old with Resolved HPV
This patient should return to routine screening in 3 years with either Pap testing alone or HPV testing with or without concurrent Pap testing. 1
Rationale Based on Risk-Based Framework
This recommendation is based on the 2019 ASCCP risk-based management guidelines, which fundamentally changed how we approach cervical cancer screening follow-up. The key principle is that management decisions are based on current risk for CIN3+, not simply on individual test results. 1
Why 3-Year Interval is Appropriate
- Current test results are reassuring: A normal Pap smear with negative HPV testing represents the lowest risk category for cervical neoplasia 1
- Previous positive HPV (non-16/18) with current clearance: When a patient had a minimally abnormal result (HPV positive for non-16/18 types) that was preceded by negative screening within the past 5 years, and now has negative results, the risk returns to baseline 1
- Age consideration: At 24 years old, this patient falls into the age group where conservative management is appropriate, as many HPV infections and even high-grade lesions are transient and destined to regress 1
Specific Management Algorithm
Current Status Assessment:
- Normal Pap smear: ✓
- Negative HPV test: ✓
- Previous HPV positive (non-16/18): ✓
- Age 24 years: ✓
Next Steps:
- Return in 3 years for repeat screening 1
- Screening can be performed with HPV testing with or without concurrent Pap testing 1
- If using Pap testing alone, 3-year interval is still appropriate given the negative HPV result 1
Critical Distinction from Older Guidelines
The 2019 guidelines represent a significant departure from 2012 recommendations. Previously, any HPV-positive result would have triggered more intensive surveillance. However, the risk-based framework recognizes that:
- HPV clearance is common in young women: The immune system typically clears HPV infections, particularly in women under 30 years 1
- Negative HPV test provides strong reassurance: Research demonstrates that negative HPV testing is associated with very low cumulative incidence of CIN3+ (0.16% over 45 months) 2
- Double negative results (Pap and HPV) confer lowest risk: This combination provides the strongest negative predictive value for future high-grade disease 2, 3
Important Caveats to Avoid Common Pitfalls
Do NOT recommend 1-year follow-up unless:
- The current Pap showed abnormalities (ASC-US, LSIL, etc.) 1
- The current HPV test was positive 1
- There was no documented negative screening within the previous 5 years before the initial HPV-positive result 1
Do NOT extend to 5-year intervals:
- Five-year intervals are only appropriate for women 30 years and older with negative cotesting 1
- This patient is 24 years old and does not meet criteria for extended intervals
Colposcopy is NOT indicated because:
- Current results are completely normal 1
- Previous HPV was not types 16 or 18, which are the only genotypes that warrant colposcopy even with normal cytology 1
- The patient has successfully cleared the infection 1
Documentation Recommendations
Ensure clear documentation includes: