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Objective: Women with postcoital bleeding (PCB) are recommended to be evaluated by colposcopy even if cytology is negative. Human papillomavirus (HPV) testing increases the detection of cervical intraepithelial neoplasia or worse compared to the Pap smear test. We aimed to determine the incidence of cervical pathology among women with persistent PCB with a negative Pap smear or HPV-DNA test. Our study, therefore, questions the place of HPV DNA test in women with PCB.
Material and Methods: The clinical data of 212 women with persistent PCB and negative cytology or negative HPV DNA test referred to colposcopy, between January 2010 and June 2019, were retrospectively evaluated.
Results: Among the 212 PCB patients, 161 (75.9%) were cytology negative and 51 (24.1%) were HPV DNA test (n=40) or co-test (n=11) (negative for HPV DNA test and cytology) negative. There were no cases of invasive cancer. The women referred with negative cytology were more likely than those with negative HPV DNA to have CIN (21/161 (13%), 1/51 (1.9%) p=0.042. Seven women (4.3%) were diagnosed with high-grade cervical dysplasia in the negative cytology group. None of the patients in the HPV DNA negative group was diagnosed with high-grade cervical dysplasia.
Conclusion: Our data show that a normal Pap smear cytology in women with PCB does not rule out the possibility of HSIL. HPV DNA testing is a useful triage test to determine if colposcopy referral is required in the context of post-coital bleeding with negative smear test.
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