To improve the sensitivity of cervical carcinoma screening and to determine the optimal management with an ASCUS Pap result we evaluated the effectiveness of combining thin layer cytologic slides (ThinPrep) and HPV DNA testing.A total of 170 women were studied with conventional Pap smears, liquid based cytology, HPV testing and colposcopy with eventual histologic evaluation.The ThinPrep method yielded 12.5% more high grade lesions than did the conventional smears (and more severe diagnoses as compared to the conventional smears). HPV prevalence was significantly associated with disease status. Of 30 patients with ASCUS, HPV testing detected 100% of high grade lesions and 67% of low grade. If colposcopy had been limited to HPV+ women, 47% of case would have been spared.Liquid based cell collection improves sensitivity for the detection of disease. For women with ASCUS cytology, HPV DNA testing of residual specimen can identify the majority of high risk cases using a single sample.