32yo, G2P2002, who presents to your practice for her annual well-woman examination. She has recently moved and is establishing care. She can’t recall the last time she had a pap smear performed, but is “pretty sure” it was more than 3 years ago. She does not smoke, has no significant FH for GYN malignancies (cervical/ovarian/breast), and is otherwise healthy. Pap smear performed in the office was cytology negative, but HPV positive.
For women ≥ 30 years of age with a cytology (-), but HPV (+) pap, you really have two options depending on your access to testing:
- If you can perform HPV DNA typing, then:
- Repeat cotesting in 1 year if HPV 16/18 (-)
- Proceed with colposcopy if HPV 16/18 (+)
- If you don’t have access to DNA typing, then
- Repeat cotesting in 1 year
- 2013 ASCCP Guidelines – http://www.asccp.org/asccp-guidelines