Special circumstances

1. Postmenopausal women may forgo immediate colposcopy and be managed by HPV DNA testing at 12 months with referral to colposcopy for positive results (high- risk HPV DNA types). Women with LSIL who have clinical or cytologic evidence of atrophy may be treated with intravaginal estrogen, followed by repeat cytol ogy seven days after completion of therapy, with referral to colposcopy if an abnormality persists. If repeat cytology is normal, then another cytology test should be obtained in four to six months. The woman can return to routine surveillance if both tests are normal, but should be referred for colposcopy if either test is ASC-US or worse.

2. Adolescents. Initial colposcopy may be deferred in adolescents. Instead, they may be managed with HPV DNA testing at 12 months with referral to colposcopy for positive results (high-risk HPV DNA types).

3. Pregnant women with LSIL are managed in a similar fashion to those with HSIL (see below). Colposcopy should be performed, with biopsy and endocervical curettage performed for any lesion suspicious for HSIL or more severe disease.

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