What is the recommended first step in follow-up for a 34-year-old with a normal Pap test and positive HPV?

The correct approach for a 34-year-old with a normal Pap test and a positive HPV test involves HPV typing to specifically identify the presence of high-risk strains, particularly HPV types 16 and 18. These strains are known for their stronger association with the development of cervical cancer.

When a Pap test is normal but the HPV test returns positive, understanding whether the specific high-risk HPV types are present helps in guiding further management. If either HPV type 16 or 18 is detected, the patient typically requires closer follow-up and possibly a colposcopy due to the increased risk of precancerous changes. In contrast, if the high-risk types are absent, the patient might be safely monitored, as the risk of developing cervical cancer is lower.

In this specific clinical context, not only is the identification of high-risk types crucial, but immediate intervention through a colposcopy may not be warranted without this additional information. Therefore, testing for HPV 16 and 18 represents an important step in determining the appropriate follow-up and ensuring the patient's health is managed effectively.