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Editor's Message  |   March 2006
Infections With Human Papillomavirus: Hope for Prevention and Guidance for Diagnosis and Management
Author Notes
  • Address correspondence to Paul M. Krueger, DO, FACOOG, Professor of Obstetrics and Gynecology, Assistant Dean for Education and Curriculum, University of Medicine and Dentistry of New Jersey–School of Osteopathic Medicine, 1 Medical Center Dr, Suite 210, Stratford, NJ 08084-1500. E-mail: krueger@umdnj.edu. 
Article Information
Preventive Medicine
Editor's Message   |   March 2006
Infections With Human Papillomavirus: Hope for Prevention and Guidance for Diagnosis and Management
The Journal of the American Osteopathic Association, March 2006, Vol. 106, ii-S1. doi:
The Journal of the American Osteopathic Association, March 2006, Vol. 106, ii-S1. doi:
Genital warts, cervical dysplasia, and subclinical human papillomavirus (HPV) infections have been a tremendous source of frustration throughout my career as a practicing obstetrician and gynecologist. Fortunately, we are about to enter a new era—the era of the HPV vaccine and the fulfillment of its potential and promise to prevent HPV-related anogenital infection and neoplasia, especially cervical cancer. 
As Anthony H. Dekker, DO, points out in this supplement, physicians will have to take a proactive role in fostering acceptance of the HPV vaccine by parents, guardians, and young female patients. And, despite the future availability of this preventive modality, physicians will still need to care for women who are already infected with the virus. Here is some guidance: 
  • Download and follow the evidence-based protocols developed by the American Society for Colposcopy and Cervical Pathology (ASCCP). The ASCCP protocols are available at: http://asccp.org/consensus.shtml.
  • Adhering to the ASCCP guidelines, physicians should follow up with colposcopies in most women who have a new Papanicolaou (Pap) test diagnosis of atypical squamous cells—cannot exclude high-grade (ASC-H), low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), or other serious abnormalities including glandular cell abnormalities.
  • I use reflex HPV DNA typing in most—but not all—clinical situations when Pap tests are read as atypical squamous cells of undetermined significance (ASCUS).
  • Screening women with too many Pap tests is just as bad as doing too few. Women with a Pap test showing ASCUS and negative typing for oncogenic HPV DNA should return to recommended routine screening intervals.
  • Pap tests plus HPV DNA typing is helpful for screening women older than 30 years but not women younger than 30 years. If both the Pap test and the HPV DNA typing show no abnormality, physicians should consider screening at 3-year intervals. Women who have Pap tests showing normal cytology and oncogenic HPV DNA should have HPV DNA typing repeated in 6 to 12 months. Women should undergo colposcopy if positive HPV DNA typing persists.
  • Physicians need to beware the patient who has a Pap test diagnosed as an HSIL and a colposcopy showing no abnormality; an excisional procedure is usually indicated.
I hope my recommendations and the articles by Bethany A. Weaver, DO, MPH; Daron G. Ferris, MD; and Anthony H. Dekker, DO, in this supplement to JAOA—The Journal of the American Osteopathic Association are helpful.