Analysis of the Management of Patients with Altered Results in the HPV Self-test: Systematic Review of the Literature

Abstract

Introduction: Human papillomavirus (HPV) self-testing has been increasingly adopted as a strategy for cervical cancer screening. However, the lack of consensus regarding clinical management after a positive result may lead to both undertreatment, with delayed diagnosis of precursor lesions or invasive cancer, and overdiagnosis with unnecessary interventions, negatively affecting quality of care and screening adherence. Objective: To compare different clinical management recommendations described in the literature for women with positive HPV self-test results in the context of cervical cancer screening. Method: A systematic review of the literature was conducted using the MEDLINE, Embase, and LILACS databases (2019–2024) to identify studies describing clinical management strategies following a positive DNA-HPV self-test. Two reviewers performed study selection independently, and the findings were synthesized narratively. Results: Seven studies were included, comprising a total of 56,580 participants. The publications were analyzed regarding management strategies adopted after positive HPV self-test results, including complementary screening methods, indications for additional diagnostic investigation, and follow-up intervals. A predominance of direct referral to colposcopy was observed for HPV 16 and 18 positive results, whereas for other high-risk genotypes, cervical cytology was frequently used as a complementary triage strategy to guide subsequent management. Conclusion: Management strategies based on HPV self-test results may contribute to optimizing cervical cancer screening and guiding care pathways across different healthcare settings.