Retesting Interval for Negative HPV and Negative Pap
For patients with both negative HPV and negative Pap (cotest negative), retest in 5 years. 1
Standard Screening Interval
- Women aged 30-65 years with negative HPV and negative Pap should undergo repeat cotesting in 5 years. 2
- This 5-year interval represents the preferred screening strategy for women in this age group with completely negative results. 2
- The alternative acceptable approach is cytology alone every 3 years, but cotesting every 5 years is preferred. 2
Risk Stratification Supporting This Interval
- The 10-year cumulative risk of CIN3+ after a negative HPV test is extremely low at 0.31%, which is similar to the 3-year risk after negative cytology alone (0.30%). 3
- Women with negative cotest results have the lowest risk profile compared to any other screening result, with a 5-year CIN3+ risk of only 0.11%. 4
- Recent data from the English HPV screening pilot demonstrated that detection of CIN3+ at second round screening after a negative HPV test was significantly lower than after cytology alone (1.21/1000 vs 4.52/1000 women screened). 5
Age-Specific Considerations
- For women under 50 years: The standard 5-year interval after negative cotest is appropriate. 5
- For women 50 years and older: The risk decreases even further with age, falling to 0.08% in women over 50 years, supporting potentially longer intervals. 3
- The 5-year interval remains standard until age 65, at which point screening can be discontinued if adequate prior negative screening history exists. 2
Requirements for Exiting Screening at Age 65
- To discontinue screening at age 65, patients must have either 3 consecutive negative cytology tests OR 2 consecutive negative cotests within the past 10 years. 2
- The most recent test must have been performed within the past 5 years. 2
- Patients must have no history of high-grade squamous intraepithelial lesions (HSIL), adenocarcinoma in situ, or cancer. 2
Common Pitfalls to Avoid
- Do not confuse negative cotest results with HPV-negative/ASC-US results, which require a 3-year follow-up interval rather than 5 years. 1, 6
- Do not extend the interval beyond 5 years for routine screening, even though the risk remains very low, as this represents the consensus guideline recommendation. 2
- Do not use cytology alone for follow-up when cotesting is available, as HPV testing or cotesting provides superior reassurance compared to cytology alone. 1