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Old 11-17-2014
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Default Exam after tomorrow, GYN question

Hi everyone,

how would you manage a 24 yo woman with ASC-US on pap? Reflex HPV or repeat cytology in 6 months?

According to 2012 USPSTF recommendations you don't perform reflex HPV testing in women younger than 30 yo. According to other sources, e.g. UW, you do perform reflex HPV test. In other words you either take another cytology sooner (up to 1 year instead of 3) or you perform an HPV test and if this comes back positive you perform a colposcopy.


I'd be very grateful for help.
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Old 11-17-2014
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Originally Posted by lieutenant dan View Post
Hi everyone,

how would you manage a 24 yo woman with ASC-US on pap? Reflex HPV or repeat cytology in 6 months?

According to 2012 USPSTF recommendations you don't perform reflex HPV testing in women younger than 30 yo. According to other sources, e.g. UW, you do perform reflex HPV test. In other words you either take another cytology sooner (up to 1 year instead of 3) or you perform an HPV test and if this comes back positive you perform a colposcopy.


I'd be very grateful for help.
Hi,
I have thought about the same question today, and consider this http://www.uptodate.com/contents/follow-up-of-low-grade-abnormal-pap-tests-beyond-the-basics?source=outline_link&view=text&anchor=H5#H5 information is usefull.
According to UpToDate and UW (number of question don't now) the best next management for this question is to repeat cytology in 12 months. If woman is 25 yo or older with ASC-US - colposcopy
Correct me if I wrong.
Good luck in your preparation!
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Old 11-17-2014
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Thank you very much, very useful source of information.

So to answer my question: up to 24 years old you just repeat pap smear in 12 months, and 25+ you do an HPV test. If the HPV tests for benign strains you check her in a year, with another pap and another HPV test. On the other hand if at the first time the HPV is positive for strains 16,18,31... you perform a colposcopy and biopsy the suspicious area.

And in a 21 - 24 year old you perform colposcopy after a second ASC-US (or whatever atypical findings).

So a 24 year old should have repeat pap smear in a year.

And I just checked UW and the woman is 26 years old so she needs a relfex HPV. UW was right, but they divide management only to adolescents and adults, so an adolescent would have to be up to 24 years old (that's obviously an adult).
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Old 11-17-2014
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Quote:
Originally Posted by lieutenant dan View Post
Thank you very much, very useful source of information.

So to answer my question: up to 24 years old you just repeat pap smear in 12 months, and 25+ you do an HPV test. If the HPV tests for benign strains you check her in a year, with another pap and another HPV test. On the other hand if at the first time the HPV is positive for strains 16,18,31... you perform a colposcopy and biopsy the suspicious area.

And in a 21 - 24 year old you perform colposcopy after a second ASC-US (or whatever atypical findings).

So a 24 year old should have repeat pap smear in a year.

And I just checked UW and the woman is 26 years old so she needs a relfex HPV. UW was right, but they divide management only to adolescents and adults, so an adolescent would have to be up to 24 years old (that's obviously an adult).
JEeeez! women are so complicated

thanks guys, it makes more sense now
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Old 11-17-2014
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Quote:
Originally Posted by lieutenant dan View Post
So to answer my question: up to 24 years old you just repeat pap smear in 12 months, and 25+ you do an HPV test. If the HPV tests for benign strains you check her in a year, with another pap and another HPV test. On the other hand if at the first time the HPV is positive for strains 16,18,31... you perform a colposcopy and biopsy the suspicious area.

And in a 21 - 24 year old you perform colposcopy after a second ASC-US (or whatever atypical findings).

So a 24 year old should have repeat pap smear in a year.
Thank you for clarification!
I totally agree with you.
Good luck on exam!
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