Question

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.

Answer

For women ≥ 30 years of age with a cytology (-), but HPV (+) pap, you really have two options depending on your access to testing:

1. If you can perform HPV DNA typing, then:
   1. Repeat cotesting in 1 year if HPV 16/18 (-)
   2. Proceed with colposcopy if HPV 16/18 (+)
2. If you don’t have access to DNA typing, then
   1. Repeat cotesting in 1 year

References

1. 2013 ASCCP Guidelines – http://www.asccp.org/asccp-guidelines