Twenty years ago I was diagnosed with HPV. I have had two breakouts of inner-vaginal warts since that time. Eight months ago, my Pap smear came back showing mild dysplasia. My gynecologist does not seem concerned, and when I asked if I needed to repeat the Pap, he said "No need." I have read that HPV can lead to cancer of the cervix. Does it sound like my gynecologist is following normal guidelines, or do I need to go to another doctor?

-- Felicity

Here's what the American College of Obstetricians and Gynecologists says about managing a Pap smear such as yours (if you want to ask your doctor about it, this is a paraphrase from Education Bulletin #183, August 1993): At a minimum, patients with "mild dysplasia" should have Paps repeated at four- to six-month intervals. If the abnormality remains, colposcopy (looking at the cervix with a microscope) should be performed. If the doctor and patient so desire, a colposcopy may be done after that first Pap smear.

Certain types of human papilloma virus (HPV) are associated with a higher risk of cervical cancer, and tests are available to determine which HPV subtype you have. In general, I recommend testing for HPV subtype if the patient opts for the follow-up Pap smear approach; that way, if there is an aggressive HPV subtype, then I know to do a colposcopy and biopsies sooner rather than later, and I will also treat it more aggressively.

As I have said many times before, if you are uncomfortable with any recommendation your doctor has made, then by all means get a second opinion!