Table 2.
| Cytological diagnosis | HPV DNA test required | Management | Histological diagnosis |
| Negative for intraepithelial lesion | No | No further intervention. Repeat Pap in 1 year | None |
| ASC-US* (Reflex HPV DNA test, then referral if positive is preferred) | Yes | If HPV+, immediate colposcopy | CIN 1 most likely |
| If HPV−, repeat Pap in 12 months | None | ||
| No | Repeat Pap in 4 to 6 months, if negative twice, resume annual Pap | None | |
| No | If ≥ ASC on repeat Pap, refer for colposcopy | CIN 1, 2, 3 | |
| No | Alternatively, refer immediately for colposcopy. Also refer if immunosuppressed† | CIN 1, 2, 3 | |
| ASC-H | No | Immediate colposcopy is preferred | CIN 1, 2, 3 |
| No | If negative histology, re-evaluate all tests, (if still negative for CIN, but ASC-H) repeat Pap at 6 & 12 months. If negative, resume annual Pap | None | |
| Yes if histology is negative | Or test HPV DNA in 12 months and repeat colposcopy if positive | CIN 1, 2, 3 | |
| LSIL‡ | No | Immediate colposcopy preferred | CIN 1 most likely |
| No | Repeat Pap at 6 & 12 months, if ≤ ASC-US, then resume annual Pap | None | |
| Yes | Test HPV at 12 months, if positive refer for colposcopy | CIN 1, 2, 3 | |
| HSIL§ | No | Immediate colposcopy | CIN 2, 3 or carcinoma in situ |
| No | Immediate excision if not pregnant, i.e. assume and treat as high-grade CIN or invasive cancer | None |
*In postmenopausal women, either refer for immediate colposcopy or if there is evidence of atrophy, treat with vaginal estrogen, then repeat cytology, if ASC-US persists, then refer for colposcopy.
†Includes HIV positive women.
‡If patient is reliable, okay to repeat Pap in 6 months, since >70% of LSIL are CIN-1 on histology.
§Rarest outcome of Pap test, <1%.
ASC, atypical squamous cells; ASC-H, atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesions; ASC-US, atypical squamous cells of undetermined significance; CIN, cervical intraepithelial neoplasia; HIV, human immunodeficiency virus; HPV, human papillomavirus; HSIL, high-grade squamous intraepithelial lesions; LSIL, low-grade squamous intraepithelial lesions.