A 58-year-old woman presents to the physician for a routine gynecological visit. She denies any acute issues and remarks that she has not been sexually active for the past year. Her last Pap test was negative for any abnormal cytology. A pelvic examination and Pap test is performed at the current visit with no remarkable findings. Which of the following approaches to cervical cancer screening is most appropriate for this patient?

Pap test and HPV test in 5 years

Discontinue screening until the patient becomes sexually active

Colposcopy at the current visit to verify Pap test results

A 27-year-old female presents to her OB/GYN for a check-up. During her visit, a pelvic exam and Pap smear are performed. The patient does not have any past medical issues and has had routine gynecologic care with normal pap smears every 3 years since age 21. The results of the Pap smear demonstrate atypical squamous cells of undetermined significance (ASCUS). Which of the following is the next best step in the management of this patient?

Perform a Loop Electrosurgical Excision Procedure (LEEP)

A 19-year-old woman presents for a sports physical. She says she feels healthy and has no concerns. Past medical history is significant for depression and seasonal allergies. Current medications are fluoxetine and oral estrogen/progesterone contraceptive pills. Family history is significant for a sister with polycystic ovarian syndrome (PCOS). The patient denies current or past use of alcohol, recreational drugs, or smoking. She reports that she has been on oral birth control pills since age 14 and uses condoms inconsistently. No history of STDs. She is sexually active with her current boyfriend, who was treated for chlamydia 2 years ago. She received and completed the HPV vaccination series starting at age 11. Her vital signs include: temperature 36.8°C (98.2°F), pulse 97/min, respiratory rate 16/min, blood pressure 120/75 mm Hg. Physical examination is unremarkable. Which of the following are the recommended guidelines for cervical cancer screening for this patient at this time?

No cervical cancer screening is indicated at this time

Cytology (pap smear) and HPV DNA co-testing every 3 years

Cytology (pap smear) every 3 years

Cytology (pap smear) and HPV DNA co-testing every 5 years

A 16-year-old male is brought to the clinic by his mother for the complaints of fever, nonproductive cough, fatigue, lack of appetite, and sore throat for the past 2 months. Several other students at his high school have had similar symptoms. Physical exam shows a whitish membrane in his oropharynx, bilateral enlarged cervical lymphadenopathy, and mild splenomegaly. Which of the following tests is most likely to diagnose his condition?

Enzyme-linked immunosorbent assay

A 52-year-old woman presents to a local hospital complaining about a rash on her face and torso, as well as night sweats, low-grade fever, diarrhea, and unintentional weight loss. Her personal history is relevant for homelessness; she also has a history of risky behaviors such as the use and abuse of intravenous drugs, and unprotected intercourse with multiple sexual partners. Upon physical examination, well-demarcated violaceous plaques and papules distributed on her face and back are visible (see image below). Additional findings include fine reticular and interstitial changes on a chest radiograph, a CD4+ count of 50 cells/mm3, and positive HIV serology. Which of the following is the most likely etiology of this patient's dermatological condition?

Human alphaherpesvirus 3 (HHV-3) infection

HPV vaccination and screening for USMLE Step 2 CK: High-Yield Microbiology Lessons

HPV & Oncogenesis - Viral Villains

High-Risk HPV (HR-HPV): Types 16, 18, 31, 33.
- Viral DNA integrates into the host genome.
- ↑ E6 oncoprotein → degrades p53 (tumor suppressor).
- ↑ E7 oncoprotein → inhibits Rb (retinoblastoma protein).
- Result: Unregulated cell cycle → potential for malignancy.
Low-Risk HPV (LR-HPV): Types 6, 11.
- Cause condylomata acuminata (anogenital warts).
- Viral DNA usually remains episomal (non-integrated).
Associated Cancers: Cervical, anal, penile, vaginal, vulvar, and oropharyngeal.

⭐ HPV types 16 and 18 account for over 70% of cervical cancers and a significant portion of other HPV-associated cancers.

HPV Vaccination - Gardasil's Guard

Gardasil 9 (9-valent): Recombinant vaccine against HPV L1 major capsid protein, forming virus-like particles (VLPs).

Targets: HPV types 6, 11 (condyloma acuminata) & 16, 18, 31, 33, 45, 52, 58 (cervical, anogenital, oropharyngeal cancers).

Administration Schedule:

Age 9-14: 2 doses at 0 and 6-12 months.
Age ≥15 or Immunocompromised: 3 doses at 0, 1-2, and 6 months.
Catch-up recommended up to age 26; shared decision-making for ages 27-45.

⭐ Vaccination does not eliminate the need for routine cervical cancer screening (e.g., Pap test) as it doesn't cover all oncogenic HPV types.

HPV infection and antibody neutralization mechanism

Cervical Cancer Screening - The Pap & HPV Hunt

Goal: Detect precancerous lesions (Cervical Intraepithelial Neoplasia, CIN) caused by high-risk HPV (hrHPV) before they progress to invasive carcinoma.
Dual Methods:
- Pap Smear (Cytology): Detects cellular atypia; looks for koilocytes.
- hrHPV Test (Virology): Detects DNA from high-risk HPV strains (e.g., 16, 18, 31, 33).

Koilocytes on Pap smear showing perinuclear halo

⭐ HPV types 16 and 18 are responsible for approximately 70% of cervical cancers. Most HPV infections are transient and clear spontaneously within 1-2 years.

High‑Yield Points - ⚡ Biggest Takeaways

High-risk HPV (16, 18) cause most cervical cancers; low-risk HPV (6, 11) cause genital warts (condylomata acuminata).

The 9-valent HPV vaccine is prophylactic and recommended before sexual debut; it does not treat active infections.

Primary screening combines Pap tests (for koilocytes) and HPV DNA testing.

Koilocytes are pathognomonic, showing a perinuclear halo and a wrinkled, "raisinoid" nucleus.

Cervical cancer screening starts at age 21, regardless of vaccination or sexual history.

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