Women with abnormal smears have an increased risk of developing cervical cancer. During the 8 years following conservative treatment of cervical intraepithelial neoplasia (CIN), their risk of invasive cervical cancer is about 5 times greater than that of the general population. Human papillomavirus (HPV) has been associated with the natural history of both CIN and cervical cancer. To date, there have been no published reports on the predictive value of HPV testing in the treatment outcome of CIN. A prospective, multi-center, cohort study was conducted on women in the Northwest of England who were attending for treatment of CIN. They were asked to complete a questionnaire, which included a detailed smoking history. Pre-and post-treatment HPV testing was performed on cervical biopsies and cervical swab, being taken with the first follow-up smear at 6 months. A nested case-control analysis was performed, cases being de- Carcinoma of the cervix is the leading cause of female cancer mortality in the developing world. 1 In developed countries, the implementation of cervical screening has had a significant impact on the incidence of cervical cancer because of the early detection of the pre-invasive disease and its effective treatment. During the 8 years following treatment of cervical intraepithelial neoplasia (CIN) the risk of invasive cervical cancer for these women remains about 5 times greater than that of the general population of women. 2 Treatment failure of CIN has been found to be associated with the size of the lesion, partially involved excision margins and the degree of CIN. 3-5 Current methods of treatment have all been associated with success rates of 90 -95%. 3,4 All treated women require follow-up to detect residual or recurrent disease, and the ability to distinguish high and low risk women for treatment failure would allow more rational protocols to be developed.Human papillomavirus (HPV) infection, particularly types 16 and 18, has been associated with the occurrence of CIN. 6 Among women with low-grade cervical smear abnormalities, high-risk HPV types are associated with high-grade underlying CIN. [7][8][9] In screened women, persistence of HPV infection has been found to be associated with a greatly increased risk of developing CIN. 10 It has been suggested that, since HPV is detected in many asymptomatic low grade CIN lesions and only a minority of persistent HPV infections progress to cancer, additional factors are necessary if malignant change is to occur. 11 One possible factor may be the exposure to chemical carcinogens such as those present in cigarette smoke. Smoking appears to be the most important factor affecting the progress of CIN after HPV infection. 12 Epidemiological evidence has already implicated cigarette smoking as a possible contributing factor to the development of cervical neoplasia. 13 Smokers have a 4-fold increased risk of developing cervical cancer compared to non-smokers. 14 Smoking is associated with the occurrence of high grade of CIN in the presence of mild dyskaryosis...

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A case of caesarean scar endometriosis is described.

Our aim was to determine the value of cervical cytology for sexually-active teenagers attending genitourinary medicine (GUM) clinics. This is a retrospective review of 57,093 women who had cervical cytology reported at the Royal Bolton Hospital (RBH) during the period 1 April 1994 to 31 March 1996. The results were subdivided into 2 age groups; < or = 19 years and > or = 20 years. Cervical cytology abnormalities within each age group were analysed and compared with the national figures for cervical cytology screening. The results were also subdivided according to their source of referral; general practitioners (GP), GUM and gynaecology. The data from each group were analysed in the same manner as before. The results of the cervical cytology screening from the RBH for major cytological abnormalities (moderate dyskaryosis and above), for the 2 age groups, were comparable and not significantly different (2.1% for each age group, P=0.909) and these figures were within the range of the national figures for cervical cytology screening (1.1%-3.4%). Subdivision of the data by source of referral demonstrated that the percentage of major abnormalities in smears performed at GUM clinics was higher than the national figure for all age groups (41/1000 for the younger age group and 37/1000 for the older age group, 12/1000 for the national figures). In conclusion, cervical cytology screening should be offered to sexually-active teenagers attending GUM clinics.

Background This service is located in a large district general hospital bordering a large UK city. It was noticed over a short period that there were several discrepant results returned for detection of Neisseria gonorrhoeae (GC) using PCR technologies and traditional culture. Aim We performed a 3-month look back at all samples sent for GC detection, in order to define local incidence of GC and discrepant results. Methods All samples sent over the preceding 3 months from this service, either as local testing or as part of the national programme, were identified using computer records and then recorded into an excel spreadsheet for comparisons (see abstract P42 table 1). Results 1245 cases were identified during the 3-month period. The total number of cases with at least one positive GC result from culture and PCR was 41 (3.29% of tested). 902 patients (72.5% of those tested) had samples sent for culture. Culture was on vancomycin-colistin-nystatin-trimethoprim enriched agar. 24 (2.7%) were reported positive for GC. There was a total of 1225 PCR based tests collected between the local and national programmes (98.4% of all cases). Abstract P42 Table 1 shows the specific methods of these two programmes. Of the 1225, 39 tests were positive (3%). All cases with a positive result were then further analysed. 27 had concordant results, that is, either the culture and PCR matched, or only one of the two tests was performed. This gave 14 patients with discordant results (1.1% of all tested, 34% of all positive results). 13 cases had a positive PCR but negative culture (93%), and one patient had a positive culture but negative PCR.

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