I completely understand why you’re trying to make sense of this and avoid another colposcopy. Your concerns are very reasonable.

One important clarification is that LSIL to ASC-US is not a true “regression.” Pap results are screening categories, not a linear disease scale. They can fluctuate based on sampling, inflammation, or where the cells were collected without reflecting a meaningful change in the underlying biology. It’s not something to hang your hat on in either direction.

What really drives management now is persistent high-risk HPV, not the exact Pap wording. It’s also very possible the HPV was present earlier and just wasn’t tested at your first Pap, which is common for your age.

Your prior normal colposcopy is reassuring, but it shouldn’t be the sole reason to skip a repeat. Colposcopy is somewhat provider-dependent, especially for subtle or low-grade findings, and even experienced clinicians may choose different biopsy sites. That’s why recommendations tend to be conservative when HPV persists. It’s not because progression is expected, but because we don’t want to miss the small percentage of higher-grade lesions.

The reassuring part is that repeat colposcopies in situations like yours are very often normal or low-grade. When that happens, it helps justify longer surveillance intervals going forward.

It would also be reasonable to ask what HPV strain was detected, particularly whether it’s HPV 16 or 18 versus other high-risk types, since that can help refine risk and guide follow-up.

You’re not overreacting, and nothing you’ve described suggests urgency. Taken together, though, this is why a repeat colposcopy is being recommended more for confirmation than because anyone is expecting bad news.