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Re: GYN: HPV Testing From: J. Hellriegel (jhellrie@pce.net) Fri Mar 24 23:00:51 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: J. Hellriegel: "Re: GYN: HPV Testing" Previous message: Efrain Ramirez: "Re: GYN: HPV Testing" In reply to: Garry Siegel: "GYN: HPV Testing" Next in thread: Joanne Bulley, MD: "Re: GYN: HPV Testing" At Fri, 24 Mar 2000, Garry Siegel wrote: > >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? For pos. HPV via tissue or Vira Pap I counsel paints for risks and STD. I treat or recommend treatment based on path report of biopsy. With satisfactory colp. and mild dysplasia, either treat or follow with Pap and colp. For higher grade lesions always treat. My choice of treatment is with a laser - ablation or cone as deemed appropriate. Have seen too many cervixes "destroyed" by multiple LEEPS. For this patient I would follow with biannual Paps. If ASCUS favor dysplasia, would colp. When I have chronic ASCUS/reactive and visual cervicitis, I culture for mycoplasma and others. Have ofter found mycoplasma and resolved problem by treatment with Doryx or other appropriate antibiotic. Would like to know approach taken by others. > >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. > I think that this would be my recommendation. >Other options: > >Colpos intermittently, realizing that her menopausal vagina and flush >cervix make colposcopy painful for her, and hard for me. > >Hysterectomy This is an option for recurrent disease or if the patient requests/demands it. J Hellriegel > >Other? > >Garry > >-- >Garry E. Siegel, M.D., F.A.C.O.G. >Roswell, GA >Private Practice > -- John Hellriegel, MD, PhD Next message: J. Hellriegel: "Re: GYN: HPV Testing" Previous message: Efrain Ramirez: "Re: GYN: HPV Testing" In reply to: Garry Siegel: "GYN: HPV Testing" Next in thread: Joanne Bulley, MD: "Re: GYN: HPV Testing"

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