I guess it is just ironic that I was looking up pap smears today. It is very confusing to say the least. The 2001 Bethesda System explains what the acronyms mean, so i'm not going to get into it. So, after you get your pap smear, 3 things can happen; they can test the fluid for HPV, they can recommend a colposcopy or they could just schedule a repeat visit. If the pap results are HSIL, LSIL, ASC-H (which just means "we can't rule out HSIL) or AIS, they are going to need a colposcopy regardless of the HPV results. If the pap comes back negative or ASC-US, then the HPV becomes important. If the pap is ASCUS and the HPV is positive, they get a colposcopy. If it is negative, the pap gets repeated in a year. If the pap is negative and the HPV is negative, the pap gets repeated in 3 years, if the HPV is positive, both the pap and HPV is repeated in 6 months to a year. And then the cycle continues....
So what happens after the colposcopy Well, if it comes back CIN 2 or 3, you send the patient for ablation and diagnostic excision. If it comes back AIS (high glandular lesion), the patient gets a hysterectomy. If the sample comes back CIN 1 , then it depends on what the pap originally was. If the pap was ASC-US, ASC-H, or LSIL, then the patient has cytology repeated at 6 and 12 months OR an HPV DNA at 12 months. If the pap was HSIL or AGC-NOS, then the patient gets a diagnostic excision, OR another colposcopy with cytology at 6 and 12 months. If the patient keeps going through this cycle with a positive CIN 1 for 2 years, then the patient can be referred for excision and ablation.
Keep in mind that the rules are different in the pregnant and adolescent.
Resources
http://download.journals.elsevierhealth.com/pdfs/journals/0002-9378/PIIS0002937807009337.pdf
http://www.asccp.org/Portals/9/docs/pdfs/Consensus%20Guidelines/algorithms_hist_07.pdf
http://www.aafp.org/afp/2009/0715/p147.html
http://www.aafp.org/afp/2003/1115/p1992.html
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