Answers

Next best step: Reflex HPV cotesting

Follow-up Recommendations: 3 years

Discussion

Atypical squamous cells of undetermined significance (ASC-US) is a common “abnormal” pap result.  The 2012 American Society of Clinical Pathologist (ASCP) recommend that women ages 21-29 should have routine cytology alone performed every 3 years as long as the results are normal.  If ASC-US results, then reflex HPV contesting is recommended.  If HPV (-), then return to routine cytology in 3 years.  If HPV (+), then proceed to colposcopy.  Another acceptable option is to have the patient return to clinic in 1 year for repeat pap.  If ASC-US (+) again, then proceed to colposcopy.  The logic is that most women in this age group clear any HPV infection without the need for colposcopy.  This is the safer choice if the patient is wanting to have more children to limit any complications of cervical incompetence.

References

1)  American Society of Clinical Pathologists. Screening Guidelines. Available at: http://www.asccp.org/guidelines/screening-guidelines.