Adolescents remain vulnerable to human papilloma virus (HPV) infection because of certain physiologic characteristics inherent in this age group and common sexual behaviors, including lack of condom use. The commonness of HPV in this age group also results in frequent abnormal cytology. Fortunately, most of the infections are transient, with frequent clearance of HPV and the lesion. Current strategies for adolescents with abnormal cytology include conservative management, avoiding invasive procedures. For cytologic atypical squamous cells of undetermined significance or squamous intraepithelial lesions (SIL), management can be obtaining cytology only at 1-year intervals for up to 2 years before referral for colposcopy is necessary. For biopsy-proven cervical intraepithelial neoplasia (CIN) I, management is similar with yearly cytology indefinitely or until high-grade–SIL or CIN II/III develops. CIN II in adherent adolescents can be managed with 6-month cytology and colposcopy.
Kathleen N. Moore and Joan L. Walker
The changes in cervical cytology characterization agreed on by the Bethesda committee meeting in 2001 created a category of atypical findings that has caused some management confusion. By description, the characterization of cervical cytology as only atypical implies a less worrisome prognosis. However, more than 40% of high-grade (CIN II or III or cancer) will be discovered within this category. The development and Food and Drug Administration approval of the Hybrid Capture 2 (HC-2; Digene Corporation, Gaithersburg, MD) for detecting high-risk human papillomavirus (HR-HPV) subtypes and the subsequent level I evidence supporting use of this test in the triage of women with atypical cytology has revolutionized the management of this cytology. With this success has come numerous additional uses for HR-HPV testing in the treatment and follow-up of women with a variety of cytologic abnormalities. This article reviews the literature on uses of HR-HPV testing in this population, with reference to currently accepted guidelines.
Edward E. Partridge, Nadeem R. Abu-Rustum, Susan M. Campos, Patrick J. Fahey, Michael Farmer, Rochelle L. Garcia, Anna Giuliano, Howard W. Jones III, Subodh M. Lele, Richard W. Lieberman, Stewart L. Massad, Mark A. Morgan, R. Kevin Reynolds, Helen E. Rhodes, Diljeet K. Singh, Karen Smith-McCune, Nelson Teng, Cornelia Liu Trimble, Fidel Valea, and Sharon Wilczynski
21 to 29 years of age with either liquid-based cytology or conventional cervical cytology smears (i.e., Pap smears). However, women with high-risk factors (e.g., a history of cervical cancer, diagnosis of cervical intraepithelial neoplasia [CIN] II