For an ASC-US Pap smear, what is the recommended initial next step?

• A. HPV DNA testing
• B. Pelvic ultrasound
• C. Repeat Pap smear in 4-6 months
• D. Colposcopy with endocervical curettage

Answer: (A)

When a Pap smear shows ASC-US, the best next step is to test for high-risk HPV to triage risk. A positive HPV test indicates a higher chance of underlying cervical precancer, leading to colposcopic evaluation to inspect the cervix more closely and sample suspicious areas. If the HPV test is negative, the risk of significant cervical disease is low, so surveillance with repeat cytology at a later interval is appropriate rather than immediate invasive procedures. Pelvic ultrasound isn’t used to evaluate cytology results, and performing a repeat Pap smear in a short interval isn’t as effective for risk stratification when HPV status is available. Colposcopy with endocervical sampling is reserved for HPV-positive results or persistent cytologic abnormalities, not as the initial step after an ASC-US result.