19 year old G0P0 presented to colposcopy clinic after PAPs in October 09 and May 10 both showed ASCUS. According to the ASCCP guidelines, a woman under the age of 20 with an ASCUS pap should have cytology repeated in 12 months. If repeat PAP at 12 months continues to show ASCUS, the cytology would again be repeated at 12 months. Only on a third ASCUS (24 months out from the original) would the patient be referred for colpo.

Unfortunately, the reason for repeat PAP at 7 mo and referral for colpo outside of guidelines was not documented in the record. Possible reasons included provider unfamiliarity with guidelines, the patient’s military status (shore vs sea duty), limited access to care, previous history not documented in record, increased risk factors. The patient is AD female on shore rotation for another 2 years, so pending sea duty rotation was not an issue as far as access to care. No history of STI, no other hx of abnormal PAP, completed Guardasil vaccine series, sexually active with 1 partner in last 12 months and 3 lifetime partners.

The WHNP discussed the lack of necessity to perform colpo at this point, but patient stated that it was not easy to get an appointment and she had already taken time off from work, so rather than wait a year and perhaps have to return, she elected to have the colposcopy performed.

Take home message for me with this patient was that it is imperative to know the current guidelines for PAP follow-up, and if going outside of those guidelines, document, document, document. It would have likely saved the patient from an unnecessary procedure, saved the provider a lot of time, and preserved the faith that the patient had in the referring provider.

The following website has the algorithms for cytology according to American Society for Colposcopy and Cervical Pathology. http://www.asccp.org/consensus.shtml