HPV testing

Testing for low-risk HPV types has no role in cervical cancer prevention. Testing for high-risk HPV types has been investigated as an intermediary test for patients with minimally abnormal cervical cytology smears (ASC-US, LSIL). For patients with ASC-US, reflex HPV testing is the preferred approach, with triage of women who test positive for high-risk HPV to colposcopy. Reflex HPV testing refers to the concurrent collection of a specimen for cervical cytology and HPV testing, with the HPV testing being performed only in case of an abnormal cytologic screen. For ASC-US, this approach is the most cost-effective and has an equal or higher sensitivity for CIN II/III at the lowest referral rate to colposcopy compared to the two alternate approaches (accelerated serial cytology or immediate colposcopy). Women with an ASC-US smear and a negative HPV test are followed with a cervical cytology smear at 1 year. The value of HPV testing for the triage of patients with LSIL is limited because nearly 85% of the lesions are HPV positive. HPV testing combined with a cervical cytology smear has been approved as a primary screening approach in the patient age 30 years and older, who still has her uterus and has no immunosuppression. If both results are negative, combined screening should not be repeated for 3 years. If cytology and HPV testing are positive, triaging to colposcopy is as outlined above. If cytology is normal, but HPV test is positive, repeat cytology and HPV test in 6-12 months is recommended, with colposcopy at that point if either test is abnormal.