Beyond Normal Cytology: Clinical Significance of HPV 16/18 Positivity in a High-Risk Adolescent — A Case Report

Abstrak

Background: High-risk human papillomavirus (HR-HPV) infection is a major etiological factor for cervical cancer. Appropriate risk-based management is essential, especially in young patients with normal cytology but positive HR-HPV test results. Case presentation: A 17-year old single female with a history of commercial sex work presented with recurrent vaginal discharge and previously treated genital warts. She reported having multiple sexual partners with inconsistent condom use after leaving sex work. Gynecological examination revealed a reddish cervix with whitish discharge, while Pap smear results were normal. However, HR HPV testing was positive. Colposcopic evaluation showed acetowhite changes at the 11–12 o’clock position with negative iodine uptake on Lugol’s test. A loop electrosurgical excision procedure (LEEP) biopsy was performed, and histopathological results were pending. Discussion: According to the 2019 ASCCP risk-based guidelines, patients with positive result of HR-HPV and normal cytology generally have a low immediate risk of CIN3+
and may be managed with surveillance. However, the presence of high-risk HPV types, particularly HPV 16/18, justifies early colposcopic evaluation despite normal cytology. The Indonesian Gynecologic Oncology (Himpunan Onkologi Ginekologi Indonesia/HOGI) guidelines similarly recommend colposcopy or visual inspection with acetic acid (VIA) in HRHPV-positive patients, followed by appropriate intervention if lesions are detected. Conclusions: This case highlights the importance of individualized, risk-based management in HR-HPV-positive patients. Early colposcopic assessment may be warranted even with normal cytology, particularly in high-risk populations, to ensure timely detection and treatment of precancerous lesions.