Question

A 28-year-old G2P2 woman returns today for follow up on her abnormal pap smear which reveals atypical squamous cells of undetermined significance (ASCUS). Reflex HPV testing is positive for high risk type. She has never had a prior abnormal pap smear, and has been following the recommended screening guidelines. She is asymptomatic. Her pelvic exam reveals a normal cervix with a small amount of cervical mucous. What is the next best step in the management of this patient?

A. Routine screening
B. Repeat Pap smear in one year
C. Repeat HPV testing in one year
D. Repeat co-testing with Pap and HPV in one year
E. Colposcopy

Answer 1

The next best step in the management of a 28-year-old woman with ASCUS findings and a positive high-risk HPV test is to undergo a colposcopy for a closer examination of the cervix. Due to her age and risk profile, immediate colposcopy is preferable to waiting for routine screening intervals.

Step-by-step explanation:

A 28-year-old G2P2 woman with an abnormal pap smear showing atypical squamous cells of undetermined significance (ASCUS) and reflex HPV testing positive for high-risk type should proceed with a colposcopy. Due to the presence of high-risk HPV and ASCUS findings, the next best step in management is to visualize the cervix more closely for any signs of dysplasia or cancer that may not be evident on the Pap smear alone.

For women over 30, cotesting with a Pap smear and an HPV test is recommended every 5 years if previous tests were negative. However, the presence of ASCUS and high-risk HPV warrants a more immediate and detailed examination through colposcopy before the routine interval.

Regular Pap testing and HPV vaccination are critical in reducing the incidence of cervical cancer, despite the lack of a cure for HPV infection itself.