ASC-US type smear : In this case, the HPV test is used as sorting. When it is negative (about 50% of cases), a control smear is offered at one year. When it is positive, immediate colposcopy is proposed. In this indication, the HPV test is fully reimbursed by Social Security.
Postoperative monitoring after cervical conization, when resection margins do not pass into a healthy zone. Viral typing, associated with the pap smear and colposcopy, allows in this indication a more relevant search for a residual lesion or a recurrence. This examination includes in this context a very good sensitivity and specificity for the detection of a residual lesion or a recurrence.
The results are usually sent to the prescribing physician within two weeks.
The results can show :
Negative viral typing.
Positive viral typing, with low risk HPV: HPV 6, 11, 40, 42, 43, 44, 55.
Positive viral typing with HPV at high risk: HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 70, 73, 82.
The result must be placed in the overall context (age of the patient, result of the smear, colposcopy, etc.), before making a therapeutic decision.
Then what ?
The patient will be seen again by the prescribing doctor of viral typing or by her gynecologist.
The therapeutic decision depends on the context. When the viral typing is positive :
ASC-US smear: immediate colposcopy.
Postoperative control after conization of the cervix: reinforced surveillance or surgical revision decision.