Regarding cervical cancer screening with primary HPV testing (co-testing with HPV + Pap smear), which group of women with HPV 16/18-positive but negative cytology requires immediate colposcopy?
- A All women aged 30–65 with any high-risk HPV type regardless of cytology
- B Women positive for HPV 16 or 18 regardless of cytology result ✓
- C Women with HPV-positive results on two consecutive annual screens
- D Women with HPV 16/18 only if cytology shows ASCUS or higher
Correct answer: B. Women positive for HPV 16 or 18 regardless of cytology result
Explanation
Current ASCCP 2019 and WHO guidelines specify that women who test positive for HPV genotypes 16 or 18 (the highest-risk genotypes accounting for ~70% of cervical cancers) should be referred for immediate colposcopy regardless of cytology result, because HPV 16/18 positivity alone carries sufficient risk of CIN2+ to warrant direct colposcopic evaluation. Women with other high-risk HPV types (not 16/18) with negative cytology are managed with 1-year repeat co-testing rather than immediate colposcopy.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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