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among women. Trichomoniasis is common among women who have HIV. Zidovudine is the drug choice for pregnant women.#40 Counseling and reduction in STIs #41 Normal Vs Abnormal Pap SmearThe Pap test is indicated to screen for malignant and premalignant lesions of the cervix. The recommended age at initiation of cervical cancer Guidelines Papsmear:Pap smear screening at age at the ag of 21 regardless of sexual historyAbnormal cytology common in young women and mostly resolve byitselfTable. Summary of 2012 Screening Guidelines from the American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology (Open Table in a new window)ParametersACS RecommendationsAge to start screeningBegin screening with cytology at 21 years old, regardless of sexual historyScreening interval age 21–29Screen with cytology alone every 3 years.* HPV testing should not be used for screening in this age group.Screening interval age 30-65Screen with a combination of cytology and HPV testing every 5 years (preferred) or cytology alone every 3 years. Screening by HPVtesting alone is generally not recommended.*Age to stop screeningAge 65, if the woman has adequate negative prior screening and is not otherwise at high risk for cervical cancerScreening after hysterectomyNot indicated for women without a cervix and without a history of ahigh-grade precancerous lesion (eg, CIN2 or CIN3) in the past 20 years or cervical cancer everHPV-vaccinated womenScreen according to the same recommendations as for unvaccinated womenInterpreting Cytology ResultsResults from cervical cytology specimens are reported according to the 2001 Bethesda System Classification, as listed below.Negative for intraepithelial lesion or malignancyEpithelial cell abnormality
Squamous cellAtypical squamous cells (ASC) of undetermined significance (ASC-US) or atypical squamous cells that cannot exclude HSIL (ASC-H)Low-grade squamous intraepithelial lesions (LSIL), includes human papillomavirus (HPV), mild dysplasia, and CIN 1High-grade squamous intraepithelial lesions (HSIL), includes moderate to severe dysplasia, carcinoma in situ, CIN 2, and CIN 3Squamous cell carcinomaGlandular cellAtypical glandular cells (AGC), specify endocervical, endometrial, or not otherwise specified (NOS)Atypical endocervical cells, favor neoplastic, specify endocervical or NOSEndocervical adenocarcinoma in situ (AIS)AdenocarcinomaWomen aged 20 years or younger with ASC-US or LSILHPV infection and minor abnormal cytology results common in adolescents, but invasive cancer is rarePer 2009 ACOG guidelines, Pap tests only recommended beginning at age 21 years, regardless of sexual history; however, Pap tests are still performed in the 20 years or younger age group in some cases because of lack of knowledge of current guidelinesConservative management preferred for this group because of the high likelihood of spontaneous resolution within 2 years of initial infection; abnormal cervical cytology