From the Guidelines
For patients with a positive HPV test, the most recent guidelines recommend rescreening in 1 year with an HPV test, with or without a concurrent Pap test, regardless of the current Pap test result, as outlined in the 2021 sexually transmitted infections treatment guidelines 1. When considering the management of patients with positive HPV results, several factors come into play, including the specific HPV genotype, concurrent cytology findings, and previous screening results.
- For patients with a positive HPV test and normal cytology (NILM), rescreening should occur in 1 year with an HPV test, with or without a concurrent Pap test 1.
- If HPV 16 or 18 is specifically positive, immediate colposcopy is recommended regardless of cytology results 1.
- For patients with HPV positive results and abnormal cytology (ASC-US or worse), colposcopy is indicated without waiting 1. Key considerations in managing positive HPV results include the risk associated with specific HPV genotypes, the natural history of HPV infections, and the potential for progression to cervical dysplasia and cancer.
- HPV 16 is considered the highest-risk HPV type, and expedited treatment should be considered for HSIL cytology results, with colposcopy recommended in all other cases, even if the cytology test is normal 1.
- HPV 18 also has a relatively high association with cancer, and colposcopy is recommended in all cases, even if the cytology test is normal 1. By following these guidelines, clinicians can balance the need for early detection of potential cervical lesions with the risk of unnecessary procedures, recognizing that most HPV infections clear spontaneously within 1-2 years 1.
From the Research
Rescreening Guidelines for Positive HPV
- The Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee developed recommendations for the use of extended genotyping results in cervical cancer prevention programs 2.
- For individuals who test positive for HPV types 16 and 18, colposcopy is recommended 2.
- For those positive for HPV 45,33/58,31,52,35/39/68, or 51 but negative for 16 or 18, triage with cytology or dual stain testing is recommended 2.
- When screening with primary HPV testing, for patients who test positive for HPV types 56/59/66 and no other carcinogenic types, repeat HPV testing in 1 year is recommended 2.
- When screening with cotesting, for those who test positive for HPV types 56/59/66 and no other carcinogenic types, the following guidelines apply:
- 1-year return is recommended for negative for intraepithelial lesion or malignancy, atypical squamous cells of undetermined significance, and low-grade squamous intraepithelial lesion 2.
- Colposcopy is recommended for atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H), atypical glandular cells, high-grade squamous intraepithelial lesion, or carcinoma 2.
Special Considerations
- When patients without prior high-grade cytology or histology are being followed, use of extended genotyping results is acceptable 2.
- When high-grade cytology or histology results are present, or when patients are being followed after treatment of CIN2+, management using the 2019 guidelines is recommended 2.