From the Guidelines
For a negative Pap test with a positive HPV result, the recommended treatment plan is to repeat the HPV test with or without a concurrent Pap test in 3 years, as per the 2019 guidelines. This approach is based on the most recent evidence from the 2021 study on sexually transmitted infections treatment guidelines 1. The management of a negative Pap test with a positive HPV result has evolved, with the 2019 guidelines recommending a less frequent follow-up compared to the 2012 guidelines.
The key considerations in managing a negative Pap test with a positive HPV result include:
- The type of HPV: If the HPV is positive for genotype HPV 16 or HPV 18, colposcopy is recommended, regardless of the Pap test result 1.
- The patient's history: If the patient has a history of high-grade lesions, colposcopy may be warranted, even with a negative Pap test and positive HPV result 1.
- The patient's age and preferences: Expedited treatment may be preferred for nonpregnant patients aged 25 years or older, after shared decision-making 1.
It is essential to note that HPV infections often clear on their own within 1-2 years without causing cell changes. Therefore, the focus is on monitoring to ensure any cell changes are detected early, rather than immediate treatment. The recommended follow-up approach balances the high likelihood of natural viral clearance against the need to detect any developing cervical abnormalities early. While waiting for the follow-up appointment, it is crucial to maintain regular healthcare visits and consider lifestyle modifications, such as not smoking, to reduce the risk of HPV persistence. Additionally, considering HPV vaccination if eligible and not fully vaccinated can provide protection against future HPV infections.
From the Research
Negative Pap, Positive HPV Treatment Plan
- A negative Pap test with a positive HPV result indicates the presence of high-risk HPV types, which can lead to cervical cancer if left untreated 2.
- The risk of precancer is less than 0.15% over 5 years following a negative HPV test result, but a positive HPV test result requires further evaluation 2.
- For people with a positive HPV test result, a combination of HPV genotyping and cervical cytology (Papanicolaou testing) can identify the risk of precancer 2.
- Treatment options for a negative Pap, positive HPV result include:
- HPV vaccination at ages 9 through 12 years can prevent more than 90% of cervical precancers and cancers 2, 3.
- A negative HPV cotest result in individuals with an unsatisfactory Pap test (UPT) predicts the lack of high-grade squamous intraepithelial lesion (HSIL) detection 4.
- Follow-up with HPV and Pap-smear tests after treatment is of great importance in the detection of residual or recurrent disease 5.