Management of Adolescents Who Have Abnormal Cytology and Histology

Adolescents have been shown to have the highest rates of human papillomavirus (HPV) infection. The cause is likely a combination of sexual risk behavior and biologic vulnerability. Most HPV and its associated abnormal cytology are transient, with frequent clearance of HPV and the lesion. These findings have resulted in new strategies, including observation, for adolescents who have abnormal cytology. For cytologic atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions, adolescents should be followed with cytology at 1-year intervals for up to 2 years before referral for colposcopy is necessary. For biopsy-proved cervical intraepithelial neoplasia (CIN) 1, management is similar, with yearly cytology indefinitely or until high-grade squamous intraepithelial lesions or CIN 2,3 develops. CIN 2,3 in compliant adolescents can be managed with 6-month cytology and colposcopy up to 2 years.