Management of women with a positive HPV test result – The different strategies
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Women should be informed of their test results by a health professional who is well conversant with counselling of women. It is important to explain that a positive HPV test result by itself does not mean that the woman has either precancer or cancer of the cervix. Because her risk of the disease is higher than that of HPV-negative women, further examination is needed. The woman may have concerns that a positive HPV test result means that her partner has had sex with someone else while they have been together. She should be reassured that someone can have HPV even if they may not have been sexually active or have not had a new partner for many years.
An HPV-positive woman may be recalled and evaluated for immediate treatment. The evaluation requires a pelvic examination, during which 3–5% dilute acetic acid is applied to the cervix and certain features are identified. More details on determining eligibility for ablative treatment are described later. The evaluation may be performed with the naked eye. Good illumination of the cervix is essential and may improve the performance of the examination with any of the portable devices that enable low-power magnification of the cervix.
The screen-and-treat strategy ensures high compliance with treatment and is appropriate in limited-resource settings where multiple visits to health facilities are often difficult for women. However, this strategy also results in a significant number of women being treated even in the absence of apparent abnormalities. Such overtreatment is a well-accepted strategy because it treats the existing lesions and also protects a significant number of HPV-positive women from developing cervical precancer or cancer in the future.