How to Explain HPV Aptima Positive with Normal PAP Results to Your Patient
Your patient has a positive high-risk HPV test with normal cervical cells, which means they need repeat testing in 1 year—not immediate colposcopy—because their recent negative screening history places them at lower immediate risk for cervical cancer. 1, 2
What This Result Means
- HPV is extremely common: Most sexually active people acquire HPV at some point in their lives, and this positive test does not mean cancer. 3
- Normal PAP is reassuring: The cervical cells look completely normal under the microscope, which significantly lowers the immediate concern. 1
- Most HPV infections clear spontaneously: Approximately 60% of HPV-positive women become negative within 6 months, and most infections resolve within 6-24 months without any treatment. 3
- The Aptima test is highly specific: This particular HPV test detects active viral gene expression (E6/E7 mRNA), making it more specific for clinically significant infections than DNA-based tests, with 97% sensitivity for high-grade lesions. 4
Why Follow-Up in 1 Year (Not Sooner or Later)
The 2019 ASCCP guidelines and 2021 CDC STI Treatment Guidelines both specify 1-year follow-up for this exact scenario. 1, 2
- Lower risk with recent negative screening: If your patient had a negative HPV test or cotest within the previous 5 years before this current positive result, their risk for high-grade cervical changes (CIN 3+) is low enough to safely defer colposcopy. 1, 2
- Time allows natural clearance: The 12-month interval gives the immune system time to clear the infection naturally, which happens in the majority of cases. 2
- Persistent infection is the real concern: HPV that remains positive at 1 year significantly elevates risk and warrants colposcopy, as persistence indicates the body is not clearing the virus effectively. 2
Critical Exception: HPV 16 or 18 Genotyping
If genotyping shows HPV 16 or 18 specifically, your patient needs immediate colposcopy regardless of normal cytology, as these genotypes carry the highest risk for CIN 3+ and cancer. 2, 3
- HPV 18 is particularly associated with adenocarcinoma and requires endocervical sampling at colposcopy. 3
- For non-16/18 high-risk HPV types, the 1-year follow-up plan remains appropriate. 2
What Happens at the 1-Year Follow-Up Visit
Repeat HPV testing with or without concurrent PAP is the preferred approach, as HPV testing is less likely to miss disease than cytology alone. 2
- If both tests are negative: Return to routine 3-year screening intervals. 2, 3
- If HPV remains positive OR cytology becomes abnormal: Immediate referral for colposcopy is required. 1, 2, 3
- If cytology is abnormal at follow-up: Colposcopy is indicated regardless of HPV status. 3
Risk Reduction Counseling
- Smoking cessation: Smoking contributes to progression of cervical changes and should be addressed. 3
- Condom use: Consistent condom use may reduce risk of cervical HPV infection and potentially decrease clearance time. 3
- HPV vaccination: Even with current HPV infection, vaccination protects against other high-risk types your patient hasn't encountered and is still recommended. 3
Common Pitfalls to Avoid
- Do not perform colposcopy immediately unless HPV 16/18 is detected—this represents overtreatment for low-risk patients with recent negative screening history. 1
- Do not extend the interval beyond 1 year for the first follow-up, as this is the evidence-based timepoint for risk stratification. 1, 2
- Do not use cytology alone at follow-up; HPV testing must be included as it's more sensitive for detecting persistent high-risk infection. 2
- Ensure the patient understands this is not cancer and does not indicate infidelity, as HPV can remain dormant for years. 3