Cervical cytology smears in sexually transmitted infection clinics in the United Kingdom

Abstract

on behalf of the British Co-operative Clinical GroupObjectives: To determine the current practice of smear taking in sexually transmitted infection (STI) clinics within the United Kingdom; what proportion of smears are taken within the national guidelines; whether clinics are screening women not covered by the national screening programme. To compare the abnormality rates of routine and opportunistic (that is, in addition to the screening recommendations) smears; the abnormality rates of smears taken within STI clinics with those taken within the community setting. Methods: A questionnaire was circulated to all clinics in May 1998. Details of screening practice were requested. The clinics then prospectively collected details of patient's age, GP registration, date and result of previous smear, and current result of all smears taken between 11 May 1998 and 25 May 1998. Results: There were 1828 smears taken in the 2 week period; 504 (27.6%) were opportunistic. Opportunistic smears had marginal significantly increased rates of low grade abnormalities but lower (but not statistically significant) high grade abnormalities than in routine smears. 231 (12.6%) of the women were not registered with a GP so would not be included in the national programme. The national rates of abnormalities were significantly higher in the STI clinics compared with the community setting. Conclusion:The majority of smears taken within STI clinics fall within the national guidelines, and 12.6% of the women would probably not otherwise have been screened. The rates of abnormality were significantly higher in the STI clinics but smears taken opportunistically were less likely to have high grade abnormalities. There is no evidence from this study to support the practice of additional smears in the presence of an eVective national cytology screening programme. (Sex Transm Inf 2001;77:107-110)

Impact of opportunistic testing in a systematic cervical cancer screening program: a nationwide registry study

“…Testing more often than the recommended screening interval (sporadic opportunistic testing) was examined in a UK study performed in clinics focused on sexually transmitted infections [ 13 ]. The authors found that sporadic opportunistic smears had marginally significantly increased rates of LSIL abnormalities but lower (not statistically significant) HSIL abnormalities than routine smears and concluded that there was no reason to depart from recommended screening intervals [ 13 ]. Their findings are in line with our results except that we identified no differences in cytological abnormalities between sporadic opportunistic cytologies and cytologies taken after invitation.…”

“…Some authors have argued that opportunistic testing is not cost effective and should not be performed [ 9 , 13 , 14 ], but the significance of opportunistic testing in detecting precancerous cervical lesions remains unclear. Furthermore, many countries suffer from low participation rates in their systematic screening programs [ 15 ], which reduces the effect of the programs.…”

Does menstrual hygiene management and water, sanitation, and hygiene predict reproductive tract infections among reproductive women in urban areas in Ethiopia?

“…One of the limitations of this study is that no diagnostic tests were used to validate the selfreported prevalence of RTIs; our estimates were based on syndromic management of curable sexually transmitted infections and other RTIs, a method recommended by the World Health Organization for low-resource settings [2,40]. However, in the absence of a laboratory diagnostic to accompany the analysis reported, this work may greatly underestimate or overestimate RTI prevalence and the true burden of RTIs.…”

An audit of Colposcopy referrals from a GU/STD clinic

“…This is similar to a Dublin GU/STD clinic (22%) [ 8 ]. It is reported that GUM patients have a higher rate of cytological abnormalities [ 9 ]. A request to abandon "opportunistic" screening in the Mid West region outside of the Irish Cervical Screening Programme (ICSP) prompted this audit.…”