# Abnormal Cervical Smear (Pap Test)

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class GS50 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Preventing Cervical Cancer: Best Practices in Pap and HPV Testing - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK557551/
- Verified date: 2026-08

## Verified against

- No dose - referral pathway, no medicine given in primary care
- Abnormal Cervical Smear (Pap Test) - disease-level clinical article (abnormal-cervical-smear-clinical.txt)

## Treatment metadata

- No drug therapy in primary care (Referral & Advice)

## Complete treatment card

```text
ABNORMAL CERVICAL SMEAR (PAP TEST)
Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class GS50 -
         condition scope only, no dose · No dose - referral pathway, no medicine given in primary
         care · Preventing Cervical Cancer: Best Practices in Pap and HPV Testing - StatPearls -
         NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK557551/
Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care,
               Abnormal Cervical Smear (Pap Test) - disease-level clinical article
               (abnormal-cervical-smear-clinical.txt)  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  TESTS (9)
    - ASCUS aged 21 to 24: repeat the smear in 1 year if HPV is positive or unknown; reflex HPV on
      the same sample is also acceptable
    - ASCUS with a negative HPV test: back to routine screening in 3 years, at any age
    - ASCUS aged 25 to 29 with positive HPV: colposcopy now, rather than waiting a year for a repeat
      smear
    - ASCUS aged 30 to 65 with HPV positive or unknown: repeat the smear within 4 months
    - LSIL: repeat the smear in 1 year
    - ASC-H or HSIL: colposcopy
    - AGC: endocervical sampling and endometrial biopsy to source the cells, plus HPV status and a
      targeted family history
    - AIS: immediate diagnostic excision with endocervical and endometrial biopsy, to confirm it and
      to measure invasion
    - Squamous cell carcinoma on cytology: immediate excision and further workup
  IF NOT THIS - what else fits (3)
    - Screening is recommended from age 21 to 65; below 21 HPV is usually cleared spontaneously
    - About 3.8% of Pap tests are abnormal
    - The test is not 100% sensitive, which is why screening is repeated rather than done once
  Source  StatPearls "Abnormal Papanicolaou Smear" (NBK560850) - the result-management chapter; it
          gives what each Bethesda category triggers (ACOG strategies), not a symptom pathway
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)    [1st line]
   Adult    An abnormal smear result (dysplasia or CIN) needs colposcopy and possible biopsy or
            excisional treatment, which is outside GP prescribing; the GP's role is explaining the
            result and arranging referral. - Refer, with advice
   Peds     Adult-only condition - paediatric section not applicable
   Source   No dose - referral pathway, no medicine given in primary care
   Why      An abnormal smear result (dysplasia or CIN) needs colposcopy and possible biopsy or
            excisional treatment, which is outside GP prescribing; the GP's role is explaining the
            result and arranging referral.
   Caution  RED FLAG - Visible cervical lesion or mass on speculum examination (suspected invasive
            cervical cancer): assess urgently and refer.
            No medicine is prescribed for this in primary care - this entry is for recognition and
            referral. Anything given is decided by the service it is referred to.
            RED FLAG - Unexplained bleeding or postmenopausal bleeding warrants evaluation for
            possible cervical cancer or neoplasm.
            RED FLAG - High-grade dysplasia (CIN 2 or worse), or postmenopausal or contact bleeding
            alongside the abnormal result: assess urgently and refer.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
```

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