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Using HPV tests for cervical cancer screening and managing HPV-positive women – a practical online guide

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Management of women with a positive HPV test result – Triage with VIA


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In settings where high-quality cytology is not available, HPV-positive women may be triaged with VIA. Women who are HPV-positive but VIA-negative (i.e. triage-negative) are advised to repeat the HPV test after 1 year for women living with HIV and after 2 years for women in the general population. Women who are both HPV-positive and VIA-positive (i.e. triage-positive) are immediately assessed for eligibility for ablative treatment in a screen, triage, and treat setting. If eligible, they are treated with thermal ablation or cryotherapy. HPV-positive and VIA-positive women who are ineligible for ablative treatment or are suspected to have invasive cancer should be appropriately referred and managed. The details of the various techniques to treat cervical precancers are described later. To learn more about the techniques of VIA, please consult the Atlas of visual inspection of the cervix with acetic acid for screening, triage, and assessment for treatment.

Women who are known to be positive for HPV16 or HPV18 may be directly assessed for eligibility for ablative treatment, whereas those who test positive for other high-risk HPV types undergo VIA for triage.

The key difference between the use of acetic acid to determine eligibility for ablative treatment and to perform VIA as a triage test for HPV-positive women is that with the former strategy all HPV-positive women are treated (either by ablation or by excision), whereas with the latter strategy HPV-positive women are treated only if the VIA test result is also positive. Women who are suspected to have cancer with either strategy are referred for appropriate management.

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