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GYN: HPV TestingFrom: Garry Siegel (garrys@mindspring.com)Fri Mar 24 19:06:14 2000
I have begun to selective test for HPV type in paps or tissue in order to try and triage follow up better. I am wondering if others have started doing so, and if so, what are common scenarios for which they test? Two cases to discuss: 1. 30 YO who had a cryo years ago, no records, with paps over that last 3 years intermittently ASCUS or reactive. In 1996, I had seen a couple of areas of unimpresssive white epithelium that were squamous atypia on biopsy. In 1997, her colpo was normal. When she was in for a pap recently, she was tested for HPV and was postive for a high risk type. The lab screwed up and didn't actually do the pap, however. So, I am wondering what follow up she needs short of doing a pap, of course. Assuming that her paps don't worsen. . . Paps 2 or 3 times a year, unless worsened than ASCUS/reactive? Colpo once or more annually, interspersed with paps? Other? Tentatively, once I talk to her, I'm likely to have her come in within 4 to 6 months to do the pap that didn't get run by the lab. 2. 44 nulliparous YO menopausal woman, menopausal after surgery/chemo/bone marrow transplant for Breast Cancer, who had a laser of her cervix for dysplasia in the late 80s, specifics unknown. After her bone marrow a couple of years ago, she came in this year and had CIS on her pap, CIS on her biopsy, and a LEEP with CIS/clear margins. Her cervix was almost flush with the vagina on one side prior to the LEEP, and now looks "worse." Her LEEP tissue was positive for high risk HPV. Normally, she would have frequent paps over the next year or two, and probably every six months forever. Other options: Colpos intermittently, realizing that her menopausal vagina and flush cervix make colposcopy painful for her, and hard for me. Hysterectomy Other? Garry
-- Garry E. Siegel, M.D., F.A.C.O.G. Roswell, GA Private Practice
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