Reliable, affordable human papilloma virus (HPV) testing makes this an excellent screening tool for triage management of ASCUS Pap smears and detection of cervical dysplasia. Major randomized trials show that reflex HPV testing with hybrid capture is at least as effective and cheaper than repeat cytology for evaluation of an ASCUS Pap. It avoids about 50% of colposcopies that would normally be performed if immediate colposcopy were done for all ASCUS Paps, while retaining excellent negative predictive value. High-risk HPV testing is the desirable strategy for women over 30, as long as there is reasonable follow-up. © 2004 American Society for Reproductive Medicine. Published by Elsevier Inc.