Snapshot A 27-year-old women presents to her gynecologist for a routine visit. She denies any acute complaints and is currently sexually active with two men. She reports consistent use of condoms and denies any abnormal vaginal smell or discharge as well as dysuria. A pap test is performed, which shows atypical squamous cells of undetermined significance (ASC-US). Her last pap test was normal. A reflex human papillomavirus (HPV) test is performed. Introduction Papanicolaou (pap) test (cytology) is a method used to screen for cervical cancer cervical cancer can be divided into two main types squamous cell carcinoma more prevalent adenocarcinoma cervical cancer mortality and incidence has decreased with its use pap test enables detection of precancerous lesions and disease in its early stages other screening tests involves testing for high-risk strains of human papillomavirus (HPV) Method the test involves obtaining cells by scraping or brushing them from the cervical os and endocervix these cells are then sent to the laboratory for cytologic analysis identifies abnormal cells in the transformation zone (T-zone) Screening Recommendations Pap test women who are 21-65 years of age perform every 3 years regardless of initiation of sexual activity Pap test and human papillomavirus (HPV) women who are 30-65 years of age perform every 5 years ideal for women who want to lengthen the screening interval Discontinuing screening women > 65 years of age with adequate prior screening Special populations hysterectomy with cervix removal and absent history of cervical intraepithelial neoplasia (CIN) grade 2 or 3 or cervical cancer do not perform screening Pap Test Results Unsatisfactory cytology Negative for intraepithelial lesion or malignancy (NILM) Intraepithelial cell abnormalities squamous cell abnormalities atypical squamous cells of undetermined significance (ASC-US) atypical squamous cells, can't exclude HSIL (ASC-H) low-grade squamous intraepithelial lesion (LSIL) high-grade squamous intraepithelial lesion (HSIL) squamous cell carcinoma (SCC) glandular cell abnormalities atypical glandular cells (AGC) Abnormal Pap Smear Management Pap Smear ManagementPap Smear Test Result21-24 Years Old25-29 Years Old≥30 Years Old & HPV Negative≥30 Years Old & HPV PositiveNormal pap test resultPap test ever 3 yearsPap test every 3 yearsCo-testing (pap and HPV testing) every 5 yearspreferredPap test every 3 yearsacceptableCo-testing in 1 yearacceptableHPV testingacceptableASC-USPap test in 1 yearpreferredReflex HPV testacceptablePap test in 1 yearacceptableReflex HPV testpreferredRepeat co-testing in 3 yearsColposcopyLSILRepeat pap test in 1 yearColposcopyRepeat pap test in 1 yearpreferredColposcopyacceptableColposcopyASC-HColposcopyColposcopyColposcopyColposcopyHSILColposcopyExcisional treatment or colposcopyExcisional treatment or colposcopyExcisional treatment or colposcopy Excisional treatments include loop electrosurgical excision procedure (LEEP) cold-knife conization laser conization