What is the recommended frequency for Pap smears in a female patient on Skyrizi (Risankizumab) with no history of cervical abnormalities?

Pap Smear Frequency for Patients on Skyrizi

Skyrizi (risankizumab) does not alter standard cervical cancer screening recommendations—follow age-based guidelines regardless of biologic therapy use.

Standard Screening Intervals Apply

Being on Skyrizi does not change your Pap smear schedule. The screening frequency depends entirely on the patient's age and prior screening history, not on medication use:

For Women Ages 21-29

• Screen every 3 years with Pap test alone 1, 2, 3
• HPV testing should NOT be used for routine screening in this age group 2, 4

For Women Ages 30-65

• Preferred: HPV co-testing with Pap test every 5 years 1, 2, 3
• Acceptable alternative: Pap test alone every 3 years 1, 2, 3
• The 5-year interval with co-testing is explicitly preferred by multiple guideline organizations 1, 4

For Women Over Age 65

• Discontinue screening if adequate prior screening with normal results (3 consecutive normal Pap tests or 2 consecutive negative co-tests within the past 10 years) 1, 3

Important Considerations for Biologic Therapy

While Skyrizi itself doesn't mandate more frequent screening, consider whether the patient has any high-risk factors that would require deviation from standard intervals:

• History of cervical cancer or CIN 2/3 requires more frequent screening 2, 4
• Immunocompromised status (though Skyrizi's immunosuppression is selective IL-23 inhibition, not broad immunosuppression like transplant medications) may warrant individualized assessment 2
• HIV-positive status requires annual or more frequent screening 2

Common Pitfalls to Avoid

• Do not over-screen: Screening more frequently than every 3 years provides less than 5% improvement in cancer detection while substantially increasing false positives and unnecessary procedures 2
• Do not confuse pelvic examination with Pap testing: Many patients believe they had a Pap test when only a pelvic exam was performed—provide clear written documentation 1, 2
• Do not avoid HPV co-testing in women ≥30 years: Co-testing allows safe extension to 5-year intervals and increases detection of CIN 3 4

Bottom line: Unless your patient has specific high-risk factors unrelated to Skyrizi use, follow standard age-based screening intervals—every 3 years for ages 21-29, and every 5 years with co-testing (or every 3 years with Pap alone) for ages 30-65. 1, 3