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Table 2 – STI Treatment Guidelines

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Comparison of 2012 and 2019 consensus recommendations for management of common abnormalities — American Society for Colposcopy and Cervical Pathology (ASCCP)

Table 2
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.

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