Management of Abnormal Pap Test Results in Non-Sexually Active Females

Initial Assessment and Management

For non-sexually active females with an abnormal Pap test result, colposcopy is recommended regardless of sexual activity status, as HPV transmission can occur through non-sexual routes and the risk of cervical neoplasia must be addressed 1, 2
The American College of Obstetricians and Gynecologists recommends immediate referral for colposcopy for women with ASC-H, LSIL, or HSIL, regardless of sexual activity status 2, 7
For women with HSIL, expedited treatment should be considered for those ≥25 years, according to the American College of Obstetricians and Gynecologists 1

If HPV testing is performed and positive for HPV 16 or 18, immediate colposcopy is recommended due to higher risk of high-grade lesions, as per the Centers for Disease Control and Prevention 8
If HPV positive for other high-risk types with normal cytology, return in 1 year is recommended, according to the American Society for Colposcopy and Cervical Pathology 8
HPV testing is not recommended for women <21 years, as stated by the American College of Obstetricians and Gynecologists 5, 6, 9

If CIN 2/3 (high-grade precancer) is found and treated, initial surveillance with HPV test or cotest at 6, 18, and 30 months is recommended, according to the American Society for Colposcopy and Cervical Pathology 8
Long-term surveillance for at least 25 years (even beyond age 65) is recommended for women who have had CIN 2/3, as per the Centers for Disease Control and Prevention 8
If using HPV testing/cotesting, testing every 3 years is recommended, according to the American College of Obstetricians and Gynecologists 2
If using cytology alone, annual testing is recommended, as stated by the American College of Obstetricians and Gynecologists 2

Do not delay colposcopy for high-grade abnormalities (HSIL, ASC-H) as these have significant risk of underlying high-grade disease, according to the American Society for Colposcopy and Cervical Pathology 6
Avoid extending screening intervals without appropriate negative HPV test results, as recommended by the Centers for Disease Control and Prevention 7