Final answer:
ACOG recommends that Pap test screening begin at the age of 21 for women, including 19 year old female patients coming in for their first gynecological examination. Co-testing with Pap and HPV tests begins at age 30, and Pap testing is not contraindicated in HIV patients.
Step-by-step explanation:
The American College of Obstetricians and Gynecologists (ACOG) recommends that 19 year old female patients should begin Pap tests at the age of 21. Therefore, the answer to the question is that a Pap test should begin when the patient is 21. The ACOG suggests that routine Pap smears be started at this age to screen for abnormalities that could indicate a risk for cervical cancer. Since the patient is currently 19 and there is no mention of immunocompromise or human immunodeficiency virus (HIV) infection, the recommendation is for her to start screening at 21. It is also recommended that women, beginning at age 30, have co-testing with Pap and HPV tests, and if both are negative, further HPV testing every five years. The guidance does not indicate that Pap testing is contraindicated in HIV patients; in fact, those with HIV may need more frequent screening due to a higher risk of abnormalities.