The primary HPV test with partial genotyping (HPV 16/18 detection) is now recommended as the preferred cervical cancer screening strategy. According to current guidelines, a woman aged 30 years who tests positive for HPV 16 but has a normal cytology (NILM) should be managed how?

• A Repeat co-testing in 3 years — HPV 16 with normal cytology is low risk
• B Cervical biopsy from all four quadrants without colposcopy
• C Colposcopy immediately — HPV 16 positivity regardless of cytology requires immediate colposcopic evaluation ✓
• D Repeat primary HPV test in 1 year before considering colposcopy

Explanation

HPV 16 and HPV 18 have a significantly higher risk of CIN3 and cervical cancer than other high-risk HPV types. The ASCCP 2019/updated guidelines apply a 'risk-based' management approach: HPV 16 positivity alone (even with normal cytology) carries a 5-year CIN3+ risk exceeding the colposcopy referral threshold (approximately 4%). Therefore, immediate colposcopy is recommended for women with HPV 16 positivity regardless of cytology result. This is different from other hrHPV types where normal cytology may allow a 1-year repeat.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.