She is single, does not smoke, and has one or two drinks of alcohol during the week. She had menarche at age 10, and her first sexual intercourse was at age 15. She has had numerous sexual partners, and she does not regularly use barrier contraception. She has been treated for pelvic inflammatory disease in the past. She has had Pap smears performed on a regular basis and has not had an abnormal smear.
Physical examination including a pelvic examination is normal.
The group that you work with recently adopted HPV typing. She has risk factors for developing cervical cancer. You should perform HPV typing at the next annual Pap test. You should refer the patient for colposcopy without waiting for further testing. In view of her sexual behavior, she should undergo HPV typing at the time of all subsequent Pap smears.