What is the best way to follow a thin-prep Pap smear when the results indicate no intraepithelial lesion or malignancy, but the patient is at high risk for human papillomavirus (HPV)? Should I do nothing, counsel the patient, repeat the Pap smear, or perform colposcopy?
—Judy Werner, DO, Dallas

The American Cancer Society recommends that women have a conventional Pap smear at yearly intervals or the more sensitive thin-prep Pap smear every two years beginning three years after she first has intercourse. A patient at high risk for HPV infection has an increased risk for developing a premalignant cervical lesion and may undergo annual screening with the thin-prep Pap smear. Annual, rather than biannual, testing increases the likelihood of detection of a cervical lesion in an early stage.
—Daniel R. Mishell Jr, MD

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