Human papillomavirus (HPV) DNA testing is recommended in all resource settings; visual inspection with acetic acid (VIA) may be used in the basic setting as a “stepping stone” that helps build health service capacity until HPV testing becomes available. Although cotesting with HPV and Papanicolaou (Pap) smear is an option in the maximal setting, the panel determined that the added value on the basis of increased costs of such dual screening is limited.
Self-collection of samples may be used for HPV testing.
The recommended age ranges and frequencies for screening are:
The guideline also provides separate screening recommendations for women who are HIV-positive, those who have recently given birth, and those who have undergone a hysterectomy.
After a positive HPV DNA testing result, VIA may be used for triage (follow-up) in basic and limited settings. If VIA was used as a primary screening with abnormal results, women should receive treatment. For other settings, HPV genotyping and/or cytology may be used for triage.
Women with abnormal triage results should receive immediate treatment in basic and limited settings, or colposcopy in all other settings.
The recommended treatment options for women with precancers (precursor lesions) are loop electrosurgical excision procedure (LEEP) or ablative treatments such as cryotherapy or cold coagulation. Twelve-month post-treatment follow-up is recommended for all settings. ■