Screening for Cervical Abnormalities
- Clinicians should perform an anatomical inventory to identify patients eligible for screening. (A*)
- Clinicians should perform screening for cervical and genital tract dysplasia and cancer in patients with HIV who have or have had a cervix and meet the below criteria for age-based screening. (A2)
- Clinicians should perform physical examinations of the vulva, vagina, and anogenital perineum at least annually and at the time of cervical cytology and to assess interval complaints. (A3) Abnormal cytology results may reflect vaginal, vulvar, or anogenital dysplasia in the absence of cervical dysplasia.
Age-Based Screening
- For patients <30 years old, testing for HPV is not recommended (A2†). For these patients, clinicians should perform cervical cytology within at least 2 years of the onset of receptive sexual activity or by age 21 years, regardless of the mode of HIV acquisition (A2), and if cytology results are normal, repeat testing every 3 years. (A2)
- For patients ≥30 years old, clinicians should perform cytology/HPV cotesting within 3 years of previous testing. (A2) If the baseline cytology and HPV test results are negative, clinicians should repeat both tests every 3 years thereafter. (A2)
- Clinicians should repeat cervical cytology after 2 months but within 4 months after a result of “insufficient specimen for analysis” has been reported. (A3)
- Clinicians should continue cervical cancer screening for patients ≥65 years old; however, factors such as a patient’s life expectancy and risk of developing cervical cancer should inform shared decision-making regarding continued screening. (A3)
Concomitant Screening for Anal Cancer and STIs
- Clinicians should perform concomitant anal cytology. If appropriate follow-up of abnormal results is not available within the clinician’s institution, a referral plan should be in place. For evidence-based recommendations, see the NYSDOH AI guideline Screening for Anal Dysplasia and Cancer in Patients With HIV.
- Regardless of a patient’s cervical cytology results, clinicians should perform routine screening for STIs as recommended in the NYSDOH AI STI guidelines.
Post-Hysterectomy Cancer Screening
- In patients with an intact cervix, clinicians should perform cervical cytology as above [a]. (A*)
- In patients with HIV who have undergone total hysterectomy (uterus and cervix removed), clinicians should screen for vaginal intraepithelial neoplasia by performing vaginal cytology with HPV cotesting and manage as noted under “age-based screening” above. (A2†)
- If a patient’s hysterectomy was performed to treat HSILs, CIN 2 or CIN 3, or AIS [a], clinicians should perform 3 consecutive annual HPV tests, after which long-term surveillance should be initiated, with HPV testing every 3 years for 25 years. (A3)
Post-Cervical Excision HPV Testing
- After a patient has undergone cervical excision, clinicians should perform cervical cytology with HPV testing as follows: at 6 months post-excision, annually until 3 sequential negative test results have been obtained, and every 3 years thereafter for at least 25 years. (A3)
