WHEN TO BEGIN PAP SMEARS

The latest guidelines recommend beginning Pap smear screening within three years after the onset of sexual activity or at age 21. I have encountered two teenagers, aged 18 and 15, who have developed low-grade squamous intraepithelial lesions (LSILs) within one year of first intercourse. Both patients have required colposcopy, and one has yet to return to normal Pap results after one year. I understand the reasoning behind the recommendations, but given these experiences, I feel I should continue counseling patients to begin Pap smears with onset of sexual activity. What are your thoughts on this issue? Is my experience atypical?
—KarrenRoberts, ARNP, Lawrence, Kan.

It is important to remember that according to the American Society for Colposcopy and Cervical Pathology’s 2002 guidelines (www.asccp.org/pdfs/consensus/algorithms.pdf. Accessed January 5, 2007), there are other options besides colposcopy when managing adolescents with LSILs.

According to the guidelines, your most accurate option is to do human papillomavirus (HPV) DNA testing 12 months after the index Pap. If testing is positive for high-risk HPV types, do colposcopy. If negative, repeat the Pap smear at 12 months. You can also follow with repeat cytology instead of colposcopic triage. There are always individual circumstances that increase a patient’s risk for HPV and, therefore, cervical cancer, and these may necessitate an individual approach.
—Julee B. Waldrop, MS, PNP (100-2)

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