II. Indications: First Colposcopy

  1. Cervical Intraepithelial Neoplasia (CIN)
  2. ASCUS Pap Smears
    1. More than one Pap Smear showing ASCUS
    2. ASCUS with HPV positive for high risk type
    3. ASCUS-H (ASCUS and cannot rule-out HGSIL)
  3. Atypical Glandular Cells (AGC)
    1. All subtypes except atypical endometrial cells
    2. Endometrial Biopsy for atypical endometrial cells

III. Interpretation: ASCUS pap and Colposcopy not CIN or cancer

  1. HPV Negative or unknown: Repeat Pap Smear in 12 months
  2. HPV Positive for High Risk Type or ASCUS-H
    1. Pap Smear at 6 and 12 months or HPV DNA at 12 months
    2. If ASCUS or CIN Pap Smear or HPV, repeat Colposcopy

IV. Interpretation: LGSIL pap and satisfactory Colposcopy not CIN or cancer

  1. Pap Smear at 6 and 12 months or HPV DNA at 12 months
  2. If ASCUS or CIN Pap Smear or HPV, repeat Colposcopy

V. Interpretation: LGSIL on Satisfactory Colposcopy

  1. Option 1 (preferred)
    1. Pap Smear at 6 and 12 months or HPV DNA at 12 months
    2. If ASCUS or CIN Pap Smear or HPV, repeat Colposcopy
      1. See protocol under Option 2
  2. Option 2: Colposcopy and Pap Smear at 12 months
    1. ASCUS or less: Annual Pap Smear
    2. CIN 1: Consider ablation or excision (see below)
    3. CIN 2-3: LEEP (see below)
  3. Additional thoughts
    1. Consider ablation or excision if HPV high risk type
    2. Consider closer surveillance for age <22 years
      1. Pap Smear every 4-6 months for 2 years

VI. Interpretation: HGSIL pap and Colposcopy confirms CIN 2 or 3

  1. Diagnostic excisional procedure (LEEP) in most cases
    1. Delay LEEP until after pregnancy (see HGSIL)
  2. Two options for follow-up after LEEP
    1. Repeat Colpo and pap or pap alone at 4-6 months or
      1. If testing negative x3, then annual Pap Smear
      2. Repeat Colposcopy for ASCUS findings or greater
    2. HPV DNA testing at 6 months after treatment
      1. HPV negative for high risk: Pap Smear annually
      2. HPV positive for high risk: Repeat Colposcopy

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