Introduction: To determine whether aggressive or expectative management of patients after two consecutive smears with atypical squamous cells of undetermined significance is preferable. To determine whether triage with high-risk human papillomavirus will identify all patients with cervical intraepithelial neoplasia grade 2 and 3. Methods: 140 of 282 patients referred for colposcopy with two consecutive smears with atypical squamous cells of undetermined significance were only treated when abnormalities suggestive of high-grade cervical intraepithelial neoplasia were present at col­poscopy. The other 142 patients underwent excision of all detected colposcopic abnormalities. Both groups were compared regard­ing the final cytological follow-up, the number of diathermy loop excisions, and the detection of cervical intraepithelial neoplasia. Retrospectively, the outcome of triage with high-risk human papillomavirus in the first group was investigated. Results: There was no significant difference in final cytological follow-up between patients managed by expectative or by aggres­sive colposcopic management. Significantly less diathermy loop excisions (p < 0.001) are performed in case of expectative man­agement. The sensitivity, specificity, negative- and positive predictive values of triage with high-risk human papillomavirus detec­tion were comparable with those of colposcopy alone. Conclusions: Patients referred with two consecutive ASC-US smears may be followed with an expectative colposcopic manage­ment and cytological follow-up. Triage with high-risk human papillomavirus will reduce the number of referrals and colposcopies, but (cytological) follow-up remains necessary in all high-risk human papillomavirus negative patients as well.