ASCUS Pap clarifications

[dexterMR2]

Hi everyone, I have a couple of things I'm hoping to clarify regarding the Pap guidelines. These are regarding the 2014 ASCCP algorithms:

1)For the ASCUS pap algorithm for 25 and older says that if you choose to do a Re-pap in 1 year and it is normal, then return to “routine screening,” with an asterisk that says “cytology every 3 years.” Does this mean that, even if you were 30 or older and previously doing cotesting q 5 years, that you now must switch to cytology q 3 years?

2)For the ASCUS pap algorithm in 21-24 year olds, after you get 1 normal repap in 1 year, it then says to continue until you get “normal x 2.” Is this an additional normal x2, or does it include the normal repap you just had? Because if it is the former, if I am counting right, wouldn't this woman have 4 paps in 4 years? (1 = ASCUS, 2 = normal, 3 and 4 = “normal x2”).

Thanks for any help y’all can offer!

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[22031 Alum]

I'm curious as to why you're asking about this. Plenty of practicing, board-certified OB/GYNs use the algorithm app or have the flow charts somewhere in their office for easy reference.

1) If you were previously cotesting, you'd have the HPV information and would be on the other side of the decision tree. Colpo if HPV+, repeat cotesting at 3 years if HPV-. So yes you'd switch from 5 to 3-year intervals.

2) It includes the repap, but as you probably know you could have anything up to LSIL and still stay on that side of the tree. You could have somebody be ASCUS --> NILM --> NILM--> back to routine screening, or ASCUS -->ASCUS --> NILM --> NILM --> back to routine screening. So yes, 4 paps in 4 years is possible.