Management of the mildly abnormal Pap smear: a conservative approach

Follow-up and management of the mildly abnormal Pap smear has been the subject of controversy in the medical literature. At Fitzsimons Army Medical Center, patients with initial Pap smears reported as "inflammatory atypia" or mild dysplasia were treated with specific therapy for vaginitis and/or cervicitis. Follow-up smears were performed 6 to 8 weeks later. Of the above groups, 80 and 58%, respectively, were negative on repeat smear. A third group of patients with Pap smears reported as consistent with human papillomavirus (HPV) were not treated but had repeat smears performed at 6 to 8 weeks. Of these, 76.4% reverted to normal. The results of the colposcopically directed cervical biopsies obtained on patients with persistently abnormal smears are reported. These findings support a conservative plan for follow-up of mildly abnormal Pap smears.