Postcoital bleeding is a predictor for cervical dysplasia

Abstract

Background Postcoital bleeding (PCB) is a common gynecological symptom that may cause concern among both patients and physicians. Current literature is inconclusive regarding management recommendations. Objective To identify risk-factors for dysplasia/cancer among patients presenting post-coital bleeding (PCB). Methods Using large health maintenance organization (HMO) database, all women reporting PCB in 2012–2015 were identified. PCB patient records in a single colposcopy center were reviewed. Age, marital status, ethnicity, gravidity, parity, BMI, smoking, PAP smear result (within 1 year of PCB presentation), colposcopy and biopsy results were recorded. Cases were matched by age and socio-economic enumeration area to controls accessing primary care clinics for routine care. Results Yearly incidence of PCB ranged from 400 to 900 per 100,000 women; highest among patients aged 26–30 years. Among the sample of 411 PCB cases with colposcopy, 201 (48.9%) had directed biopsy. Biopsy results included 68 cervicitis (33.8%), 61 koilocytosis/CIN 1/condyloma (30.3%), 44 normal tissue (21.9%), 25 cervical polyp (12.4%), 2 CIN 2/3 (1%) and 1 carcinoma (0.5%). Positive predictive value for koilocytosis/CIN 1 or higher pathology was 15.6% (64/411) and 0.7% for CIN 2 or higher grade pathology (3/411). In conditional logistic regression, multiparty was a protective factor: OR 0.39 (95% CI 0.22–0.88, P = 0.02), while pathological PAP smear was a related risk-factor: OR 3.3 (95% CI 1.31–8.35, P = 0.01). When compared to controls, PCB patients were significantly (P = 0.04) more likely to present CIN 1 or higher grade pathology (OR 1.82, 95% CI 1.02–3.33). Conclusions Study results indicate that PCB may require colposcopy, especially for nulliparous women with an abnormal PAP smear.

Relación de Lesiones Cervicales: Factores Demográficos, Historia Reproductiva y Tamizaje

“…La sinusorragia podría servir como una señal de alarma para las mujeres y los profesionales de la salud, lo que podría llevar a una evaluación más temprana y potencialmente a un diagnóstico y tratamiento oportuno. Así mismo, nuestro estudio respalda la sugerencia de Cohen et al (14) de que el sangrado poscoital está asociado con un mayor riesgo de lesiones cervicales y cáncer de cuello uterino, ya que las pacientes que presentaron sangrado poscoital tenían mayor predisposición a esas patologías en mención en comparación con los controles (OR 1,82, IC 95% 1,02-3,33).…”

Colposcopy—A Valuable Diagnostic Tool for Pregnant Women With Unexplained Vaginal Bleeding

“…Therefore, they suggested that these women could avoid colposcopy unless cervical cancer is clinically suspected. On the other hand, Cohen et al 21 reported that compared with controls, women with postcoital bleeding were significantly more likely to have CIN 1 or higher-grade pathology (odds ratio = 1.82, 95% CI = 1.02–3.33, p = .04). Importantly, only half of the women in our study who presented with postcoital bleeding had performed a Pap smear before pregnancy and none of them had been vaccinated against HPV.…”

Colposcopic outcomes for symptomatic patients with a negative oncogenic human papillomavirus test

“…Aetiologies of bleeding were identified as ectropion in 36% and polyps in 3.6%, similar to previously published rates of ectropion in 2–34%, polyps in 4–15%, cervicitis in 33%, and no cause identified in >50%. 6 , 7 , 8 , 10 , 11 , 12 The NCSP and Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommend GPs investigate symptomatic patients for reversible causes. 13 Despite this, 41% (46/112) overall and 32% under age 25 did not have pre‐referral chlamydia and gonorrhoea testing.…”