Management After Negative HPV and Pap Test Results
Return for routine screening in 3 years with either Pap testing alone or co-testing (Pap plus HPV testing). 1
Screening Interval Recommendation
Your negative co-test result (both Pap and HPV negative) represents the lowest risk category for cervical neoplasia, with a 5-year risk of high-grade precancer (CIN3+) of only 0.11% and cervical cancer risk of 0.014%. 2, 3
Age-Based Management:
For women aged 30-65 years:
- Return in 3 years for repeat screening 1
- Screening options include:
For women aged 21-29 years:
Why 3 Years (Not 5 Years)?
While your negative co-test result indicates very low risk, 5-year intervals are only appropriate for women aged 30 years and older with negative co-testing. 1 The evidence shows that negative HPV plus negative Pap testing provides exceptional reassurance, with a negative predictive value of 99.9% for high-grade lesions over the subsequent 3-4 years. 5, 3
Important Clinical Context
The research demonstrates that:
- Women with double-negative tests (HPV negative/Pap negative) have significantly lower risk than those with negative Pap alone (0.11% vs 0.31% 5-year CIN3+ risk) 2
- A negative HPV test is particularly reassuring and associated with decreased risk of cervical neoplasia 5
- Both cytology and HPV testing can occasionally miss significant lesions when used alone, which is why co-testing provides the most comprehensive screening 6
Common Pitfalls to Avoid
- Do not extend screening intervals beyond recommended guidelines without appropriate negative test results 7
- Do not discontinue screening before age 65 unless you have documented adequate negative screening history (2 consecutive negative co-tests or 3 consecutive negative Pap tests in the past 10 years, with the most recent test within 5 years) 4
- Do not assume you need annual screening with these negative results—this represents overscreening and is not evidence-based 1