Pap

Question 1

When to start pap screening

Answer 1

at age 21 (NO EARLIER)

or within 3 years of sexual debut

Question 2

Why do we start pap screening at age 21 and not earlier

Answer 2

younger women commonly have HPV
± dysplasia
but dysplasia commonly resolves in >90% of cases within 24 mo
so leads to a lot of unnecessary testing

Question 3

How often to do pap on ages 21-29

Answer 3

cytology q3 yr

HPV testing only if +

Question 4

How often to do pap on ages 30-65

Answer 4

cytology + HPV q5 yr

or cytology q3 yr

Question 5

In which patients do you do paps more regularly

Answer 5

known HPV 16,18 (duh)

immunocompromised, HIV+, DES exposure in utero

Question 6

How often to do pap on ages 65+

Answer 6

no more screening

Question 7

Which HPV strains cause cervical cancer

Answer 7

16, 18

Question 8

Which HPV strains cause warts

Answer 8

6, 11

Question 9

What do you do if cytology is -, HPV +

Answer 9

repeat co-testing in 1 yr or

immediate typing

Question 10

If you find HPV +

Answer 10

perform coloscopy

Question 11

Follow-up for grade 2 dysplasia and above

Answer 11

regular paps for 2 years

even if that goes past age 65