Question

A 24 year old female returns to her physician after a routine Pap smear showed atypical squamous cells of undetermined significance. She has no past history of abnormal Pap smears or sexually-transmitted infections, and other testing from her last visit (including beta-hCG and testing for gonorrhea and chlamydia) was negative. She has a lifetime total of four sexual partners, and is currently sexually active with one partner, using only an oral contraceptive pill for birth control. Menarche was at age 11, and menses have been unremarkable. PCR reveals the presence of human papillomavirus DNA, type 18. Which of the following is the most appropriate next step in the management of this patient?

A. Rapid plasma reagin (RPR) testing
B. Begin imiquimod
C. Endometrial biopsy
D. Colposcopy
E. Reassurance and routine follow-up

Answer 1

D. Colposcopy

The most appropriate next step in managing a 24-year-old female with ASCUS on her Pap smear and positive HPV type 18 is to perform a colposcopy. This procedure allows for a detailed examination of the cervix to detect possible precancerous changes. Other suggested steps such as endometrial biopsy or treatments like Imiquimod are not relevant to her current condition.

Step-by-step explanation:

A 24-year-old female with atypical squamous cells of undetermined significance (ASCUS) on her Pap smear and a positive human papillomavirus (HPV) type 18 DNA test is in a situation where the most appropriate next step in management is a colposcopy.

Colposcopy is a diagnostic procedure used to closely examine the cervix for signs of disease using a special instrument called a colposcope. It often follows an abnormal Pap smear result, especially when high-risk HPV types like 18 are involved, as HPV 18 is associated with an increased risk of cervical cancer.

Reassurance and routine follow-up might not be sufficient due to the presence of high-risk HPV. An endometrial biopsy is generally not indicated in this scenario without evidence of glandular cell abnormalities, and Imiquimod is a treatment for visible genital warts, which is not applicable here. The RPR test is used for diagnosing syphilis, not related to HPV infection.