Management of ASCUS Pap with HPV 18 Positivity

Rationale for Colposcopy Recommendation

The Centers for Disease Control and Prevention recommends colposcopy for patients with ASCUS Pap result and positive HPV 18, due to the relatively high association of HPV 18 with cervical cancer, even if the cytology test is normal 1, 2, 3
HPV 18 has a relatively high association with cancer, particularly adenocarcinoma, making immediate colposcopy the standard of care 1, 2
Because of the association of HPV 18 with adenocarcinoma, endocervical sampling is acceptable at the time of colposcopy 1, 3

The CDC recommends immediate referral for colposcopy for ASCUS with HPV 18 positivity 2, 3
Endocervical sampling should be performed during colposcopy due to HPV 18's association with adenocarcinoma 1
If high-grade lesions are found and treated, surveillance should continue for at least 25 years 1
Initial post-treatment testing includes HPV test or cotest at 6, 18, and 30 months 3

The recommendation for colposcopy with HPV 18 positivity is consistent across multiple guidelines and is based on the higher risk of progression to cancer 1, 2

HPV testing or cotesting is preferred to cytology testing alone for follow-up after an abnormal test result 3
Ideally, cytology testing should be performed by the laboratory as a reflex test from the same specimen to avoid the need for the patient to return to the clinic 1

Do not delay colposcopy for ASCUS with HPV 18 positivity, as this differs from management of ASCUS with non-16/18 HPV types 1