Table 2 – STI Treatment Guidelines
Comparison of 2012 and 2019 consensus recommendations for management of common abnormalities — American Society for Colposcopy and Cervical Pathology (ASCCP)
| Current HPV result | Current Pap test result | Previous result | Management by 2012 guidelines | Management by 2019 guidelines |
|---|---|---|---|---|
| Negative | ASC-US | Unknown or HPV negative* | Repeat Pap plus HPV testing in 3 yrs | Repeat HPV test with or without concurrent Pap test in 3 yrs |
| Negative | LSIL | Unknown or HPV negative* | Repeat Pap plus HPV testing in 1 yr preferred, colposcopy acceptable | Repeat HPV test with or without concurrent Pap test in 1 yr |
| Negative | ASC-H | Noncontributory | Colposcopy | Colposcopy |
| Noncontributory | AGC | Noncontributory | Colposcopy | Colposcopy |
| Positive | NILM | Unknown or HPV negative* | Repeat Pap plus HPV testing in 1 yr | Repeat HPV test with or without concurrent Pap test in 1 yr |
| Positive | NILM | HPV positive† | Colposcopy | Colposcopy |
| Positive for genotype HPV 16, HPV 18, or both | NILM | Noncontributory | Colposcopy | Colposcopy |
| Positive for genotype HPV 16, HPV 18, or both | ASC-US or LSIL | Noncontributory | Not applicable, genotyping not recommended for ASC-US or LSIL in 2012 | Colposcopy |
| Positive | ASC-US or LSIL | Unknown or HPV positive | Colposcopy | Colposcopy |
| Positive | ASC-US or LSIL | Negative screening results with HPV testing or HPV plus Pap testing within the previous 5 yrs | Colposcopy | Repeat HPV test with or without concurrent Pap test in 1 yr§ |
| Positive | ASC-US or LSIL | Colposcopy confirming the absence of high-grade lesion within the past yr | Colposcopy | Repeat HPV test with or without concurrent Pap test in 1 yr§ |
| Positive | ASC-H | Noncontributory | Colposcopy | Colposcopy or expedited treatment |
| Positive untyped, positive for genotype other than HPV 16, or negative | HSIL | Noncontributory | Colposcopy or expedited treatment | Colposcopy or expedited treatment |
| Positive for genotype HPV 16 | HSIL | Noncontributory | Colposcopy or expedited treatment | Expedited treatment¶ |
Sources: Massad LS, Einstein MH, Huh WK, et al.; 2012 ASCCP Consensus Guidelines Conference. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol 2013;121:829–46; Perkins RB, Guido RS, Castle PE, et al; 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis 2020;24:102–31; Perkins R, Guido R, Saraiya M, et al. Summary of current guidelines for cervical cancer screening and management of abnormal test results: 2016–2020. J Womens Health (Larchmt) 2021;30:5–13.
Abbreviations: AGC = atypical glandular cells; AIS = adenocarcinoma in situ; ASC-H = atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion; ASC-US = atypical squamous cells of undetermined significance; CIN = cervical intraepithelial neoplasia; HPV = human papillomavirus; HSIL = high-grade squamous intraepithelial lesion; LSIL = low-grade squamous intraepithelial lesion; NILM = negative for intraepithelial lesion or malignancy; Pap = Papanicolaou.
* Colposcopy may be warranted for patients with a history of high-grade lesions (CIN 2 or CIN 3, histologic or cytologic HSIL, ASC-H, AGC, or AIS).
† Previous Pap test results do not modify the recommendation; colposcopy is always recommended for two consecutive HPV-positive tests
§ Negative HPV test or cotest (HPV plus Pap test) results only reduce risk sufficiently to defer colposcopy if performed for screening purposes within the last 5 years. Colposcopy is still warranted if negative HPV test or cotest results occurred in the context of surveillance for a previous abnormal result.
¶ Expedited treatment is preferred for nonpregnant patients aged ≥25 years. Colposcopy with biopsy is an acceptable option if desired by patient after shared decision-making.