- If a patient has an ASCUS or LSIL result on colposcopy, reflex HPV testing can help with triaging the patient to either colposcopy or repeat PAP test (if a patient has anything higher than LSIL, then the yield of HPV is low as it is very likely that this patient is HPV positive and will require colposcopy regardless)
- If HPV is positive, then this is likely a true result and the patient can be referred for colposcopy
- If HPV is negative, then return to routine screening (in 3 years) as if cytology was negative in the first place
- If a patient has HPV, it takes 10 years for the cervix to develop a pre-cancerous lesion (which is why screening age of onset is moving from 21 to 25 years, with the assumption that average age of first sexual encounter is between 15 to 20 years)
- It takes 4 years on average for a non-smoker to clear HPV once they have acquired it. It takes a smoker even longer.
- Women with immunocompromising conditions or on immunosuppressants would require yearly PAP tests
- Post-coital bleeding always require a referral to gynecologist for colposcopy even if their PAP test was negative because you MUST rule out cervical cancer.
- All post-menopausal women with benign endometrial cells (BEC) on PAP test require further evaluation and referral to gynaecologist for endometrial sampling. If pre-menopausal then this is a normal finding that can vary with periods.
- If a patient has a more than 1 degree difference between their cytology findings and their biopsy findings, they will require a LEEP procedure.
- If you get a report from a gynecologist that says inadequate colposcopy, it’s because they were not able to see the transformation zone which is common in post-menopausal women.
Follow up of various PAP test results
ASCUS
Repeat PAP test in 6 months
OR
HPV testing. If HPV positive, refer directly to colposcopy. If HPV negative, patient is average risk and repeat PAP test in 3 years.
LSIL
Repeat PAP test in 6 months.
OR
HPV testing. If HPV positive, refer directly to colposcopy. If HPV negative, patient is average risk and repeat PAP test in 3 years.
BEC
If pre-menopausal this is normal. Patient is average risk. Repeat PAP test in 3 years.
If post-menopausal, referral to gynecologist for endometrial sampling.
ASC-H
Go straight to colposcopy.
HSIL
Go straight to colposcopy.
AGC
Go straight to colposcopy.