Human papillomavirus (HPV) DNA testing is recommended in all resource settings; visual inspection with acetic acid (VIA) may be used in the basic setting as a “stepping stone” that helps build health service capacity until HPV testing becomes available. Although cotesting with HPV and Papanicolaou (Pap) smear is an option in the maximal setting, the panel determined that the added value on the basis of increased costs of such dual screening is limited.

Self-collection of samples may be used for HPV testing.

The recommended age ranges and frequencies for screening are:

• Maximal setting: ages 25 to 65 years, every 5 years (≥ 9 screens in a lifetime)
• Enhanced setting: ages 30 to 65 years, if two consecutive negative tests at 5-year intervals, then every 10 years (≥ 5 screens in a lifetime) 
• Limited setting: ages 30 to 49 years, every 10 years (≥ 3 screens in a ­lifetime)
• Basic setting: ages 30 to 49 years, 1 to 3 times during that age range (≥ 1 screen in a lifetime).

The guideline also provides separate screening recommendations for women who are HIV-positive, those who have recently given birth, and those who have undergone a hysterectomy.

After a positive HPV DNA testing result, VIA may be used for triage (follow-up) in basic and limited settings. If VIA was used as a primary screening with abnormal results, women should receive treatment. For other settings, HPV genotyping and/or cytology may be used for triage.

Women with abnormal triage results should receive immediate treatment in basic and limited settings, or colposcopy in all other settings.

The recommended treatment options for women with precancers (precursor lesions) are loop electrosurgical excision procedure (LEEP) or ablative treatments such as cryotherapy or cold coagulation. Twelve-month post-treatment follow-up is recommended for all settings. ■