What are the guidelines for a 26-year-old female undergoing her first Pap (Papanicolau) test without Human Papillomavirus (HPV) testing available?

Cervical Cancer Screening for a 26-Year-Old Woman's First Pap Test

For a 26-year-old woman undergoing her first Pap test without HPV testing available, perform cytology alone and schedule the next screening in 3 years if results are normal. 1

Screening Approach for This Patient

Initial Testing

• Perform Pap test (cytology) alone at this visit, as this patient falls within the 21-29 year age group where HPV testing is not recommended for routine screening 2, 1
• HPV testing should not be used in women aged 21-29 years for screening purposes, even when available 2, 1

Follow-Up Interval After Normal Results

• If the Pap test is normal, schedule the next screening in 3 years 1, 3
• This 3-year interval is the current standard recommendation from the American College of Obstetricians and Gynecologists for women aged 21-29 years 1, 3
• The older 2010 CDC guidelines mentioned 2-year intervals, but current consensus supports 3-year intervals for this age group 2, 1

Management of Abnormal Results (If Applicable)

If ASC-US (Atypical Squamous Cells of Undetermined Significance)

Since HPV testing is not available, you have two management options for women ≥21 years with ASC-US 2:

1. Repeat Pap tests at 6 and 12 months until two consecutive negative results are obtained 2
2. Prompt colposcopy if concerns exist about patient adherence to follow-up 2

If LSIL or HSIL

• Refer for colposcopy and colposcopically-directed biopsy as indicated 2
• Ensure referral protocols are in place if your clinic cannot provide colposcopic follow-up 2

Critical Patient Education Points

Documentation and Communication

• Provide written documentation stating that a Pap test was obtained during this visit 2, 1
• This is essential because many women mistakenly believe a Pap test was performed when only a pelvic examination occurred 2
• Self-reports of Pap test completion are frequently inaccurate and require clinical record verification 1

Counseling Topics to Address

Discuss the following with the patient 2:

• The purpose and importance of Pap testing for cervical cancer prevention
• The need for regularly scheduled Pap tests every 3 years between ages 21-29 years
• That she received a Pap test today
• When to return for her next screening (3 years if normal)

Common Pitfalls to Avoid

Do Not Over-Screen

• Avoid annual Pap tests in this age group—they provide less than 5% improvement in screening effectiveness compared to 3-year intervals while significantly increasing costs and potential harms from false positives 1, 3
• Do not use HPV testing for routine screening in women under 30 years, as HPV infection is common and usually transient in this age group 2, 4

Ensure Proper Follow-Up Systems

• Establish protocols to identify and contact women who miss follow-up appointments if abnormal results are found 2
• Document Pap test results, type and location of follow-up appointments, and results of follow-up in the clinical record 2

Technical Considerations

• If the patient is menstruating, postpone conventional cytology and reschedule at the earliest opportunity 2
• The presence of mucopurulent discharge should not delay the Pap test—it can be performed after careful removal of discharge with a saline-soaked cotton swab 2
• Use CLIA-certified laboratories that report findings according to Bethesda terminology 2