From the Guidelines
For a 36-year-old woman with a positive HPV test, you should follow up with your healthcare provider for a repeat HPV test and Pap smear in 1 year, as recommended by the most recent guidelines 1. This follow-up timing is standard for HPV-positive results without abnormal cervical cells. The guidelines suggest that if the HPV type is not HPV 16 or 18, and the cytology test is normal, return in 1 year is recommended in most cases 1. Some key points to consider include:
- HPV testing or cotesting is preferred to cytology testing alone for follow-up after an abnormal test result 1
- Negative HPV testing or cotesting is less likely to miss disease than normal cytology testing alone 1
- Cytology testing is recommended more often than HPV testing or cotesting for follow-up of abnormal results 1 If your follow-up testing shows persistent HPV infection or any abnormal cells, your provider may recommend additional testing such as colposcopy (a detailed examination of the cervix). HPV infections are very common and often clear on their own within 1-2 years without causing problems. The follow-up testing is important because persistent high-risk HPV infections can potentially lead to cervical cell changes over time. Make sure to discuss any symptoms like unusual bleeding or discharge with your healthcare provider, as these might warrant earlier evaluation. It's also important to note that the American Cancer Society recommends routine HPV vaccination principally for girls aged 11 to 12 years, but also for females aged 13 to 18 years to “catch up” those who missed the opportunity to be vaccinated, or who need to complete the vaccination series 1. However, the most recent guidelines from 2021 should be prioritized when making decisions about follow-up care 1.
From the Research
Follow-up for HPV Positive Result
- A 36-year-old female with a positive HPV result should follow up based on the guidelines for cervical cancer screening and the specific type of HPV detected 2, 3, 4, 5, 6.
- The follow-up protocol may include colposcopy, biopsy, and HPV genotyping to determine the presence of high-risk HPV types such as HPV 16,18, or 45 3, 4, 6.
- Women with normal cervical cytology and a positive HPV test result may be referred for colposcopy and biopsy to rule out high-grade squamous intraepithelial lesions (HSIL) or cervical cancer 2, 3, 4.
- The timing of follow-up may vary depending on the specific HPV type, age, and other risk factors, but generally, women with a positive HPV result are recommended to have a follow-up appointment in 3 years if the result is negative for high-risk HPV types 2.
- DNA ploidy analysis has been shown to be a useful triage test for women with a positive HPV result, offering high sensitivity and specificity for detecting HSIL and cervical cancer 4.
- HPV genotyping, particularly for HPV 16,18, and 45, can help stratify cancer risk and guide follow-up management 3, 6.