Take this quick quiz

This is an easy one!  

A 22-year-old woman presents for follow-up after a first-time cervical screening test.

She has never taken oral contraceptives and is sexually active with one of three total lifetime partners.

Her past medical history is insignificant with no prior sexually transmitted infections.

On her cervical cytology slide, a cluster of undifferentiated cells with hyperchromatic, enlarged nuclei and surrounding halos is found.

Based on these findings, what is the next best step in the management of this patient?

  • HPV testing
  • Repeat Pap test in a year
  • Colposcopy
  • HPV vaccine

You can check your answer under the image.

Image credit: @Cytotech1.

Answer: Repeat Pap test in a year

Cervical cancers usually develop over the course of many years.

The two most common screening tests are the cervical cytology (Pap) test and the human papillomavirus (HPV) test, which identifies viral components capable of inducing precancerous cellular changes.*

The image above shows koilocytes, or HPV-infected cervical cells.

Koilocytic changes are now recognised as ‘low-grade squamous intraepithelial lesions’ (LSIL).

Note: Coloscopy is not recommended for LSIL in under 30 year-olds, according to NHMRC guidelines. Correct management includes repeat Pap test in a year.  If symptomatic, e.g. post-coital bleeding then colposcopy may be part of clinical management.

In the new guidelines, management will depend on the HPV strain (i.e. 16/18 or non 16/18 oncogenic virus) and reflex cytology result.