From the Guidelines
The next best management for a self-collected Pap smear with non-16 and 18 HPV positive result is to return in 1 year for follow-up testing, as the risk of cervical dysplasia or cancer is lower with non-16/18 HPV types and a normal cytology test result. According to the 2021 sexually transmitted infections treatment guidelines 1, 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. This approach is based on the understanding that while non-16/18 HPV types can still cause cellular changes, the risk is lower compared to HPV 16 and 18, which are responsible for the majority of cervical cancers.
- Key points to consider in management include:
- HPV testing or cotesting is preferred to cytology testing alone for follow-up after an abnormal test result, as it is less likely to miss disease than normal cytology testing alone 1.
- The follow-up interval may vary depending on the specific test results and the patient's history, but annual testing with cytology is recommended when HPV testing or cotesting is not used 1.
- It is crucial to adhere to the recommended follow-up schedule, even in the absence of symptoms, to ensure early detection and treatment of any potential cervical abnormalities.
- The decision to return in 1 year for follow-up testing is supported by the guidelines, which emphasize the importance of balancing the risk of disease with the potential harms of overtreatment and the need for efficient use of healthcare resources 1.
From the Research
Next Best Management for Non 16 and 18 HPV Positive Self-Collected Pap Smear
- The management of a self-collected pap smear that is non 16 and 18 HPV positive is not directly addressed in the provided studies, however, some general guidelines can be inferred from the available evidence 2, 3, 4, 5, 6.
- According to the study by 4, primary care clinicians should recognize the degrees of risk of high-grade CIN and cancer conferred by cytology, HPV subtype, and persistence of HPV infection.
- The study by 3 suggests that the incorporation of HPV testing into the present Pap screening program has the potential to make screening for cervical cancer more effective.
- The American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines, as mentioned in 4, recommend that primary care clinicians should develop clinic-based systems to ensure appropriate follow-up of abnormal cytology, positive high-risk HPV testing, diagnosed CIN, and cervical cancer.
- The study by 6 compared test results of the Pap test and 4 different HPV test systems of self-collected and physician-collected vaginal specimens, and found that self-collected Pap tests can provide a test result with a very high positive predictive value.
- Based on the available evidence, the next best management for a non 16 and 18 HPV positive self-collected pap smear may include:
- Colposcopy examination and colposcopy-guided biopsy, if needed 2, 3
- HPV testing to detect the presence of high-risk HPV types 3, 5
- Follow-up and surveillance, as recommended by the ASCCP guidelines 4
- Consideration of self-collected Pap tests as a screening tool, especially in countries with a low income level 6