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

This section describes the algorithm for managing an HPV-positive woman with Pap smear cytology. If the sample was collected by a health provider from the cervix in an appropriate transport medium (e.g. in a tube containing PreservCyt, SurePath, or Roche medium), then the same sample may be used for liquid-based cytology. The woman need not be recalled. However, liquid-based cytology is not feasible on self-collected specimens or on specimens that were not collected in an appropriate medium. In such cases, the woman needs to be recalled for the collection of another sample by a provider. The same applies in settings with facilities for conventional Pap smear but not liquid-based cytology.

Women with abnormal cytology are referred for colposcopy. The colposcope enables examination of the cervix under a good light source and with different levels of magnification. Depending on the results of the colposcopic examination, a colposcopist may decide to either take a biopsy from the abnormal area or proceed directly to treatment. HPV-positive women with a normal colposcopy result should be reassured and advised to have a repeat HPV test after 2 years. The HPV test is to be repeated after 1 year in women living with HIV.

To learn more about colposcopy, access the Atlas of Colposcopy: Principles and Practice.

The algorithm may be slightly different when partial genotyping information is provided simultaneously by the HPV test. Women who are known to be positive for HPV16 or HPV18 may be directly referred for colposcopy, whereas those who test positive for other high-risk HPV types undergo cytology for triage.

In either algorithm, women with no abnormalities detected on cytology are advised to have a repeat HPV test after 2 years, and those who test positive on the repeat HPV test are directly referred for colposcopy. The HPV test is to be repeated after 1 year in women living with HIV.