What is the recommendation for monitoring or treating Pap smear results that show inflammation without any other abnormalities? Is this age-dependent? — Mary Ryan, MSN, ARNP, FNP-C, Shawnee Mission, Kan.
Inflammation on a Pap smear can be found in a patient of any age and may be attributable to a benign infection—such as Candida vaginitis—that need be treated only if the patient is symptomatic. Sexually transmitted infections can also cause an inflammatory reaction on the cervix and should be treated accordingly.
If a Pap result comes back as “inflammation,” but the smear is otherwise satisfactory (assuming the previous test was satisfactory and normal), the Pap should be repeated in one year. The one exception would be if the patient is HIV-positive, in which case she needs a follow-up Pap in four to six months.
There have been many recent changes in the recommendations as to how frequently Pap smears should be done. Although the main professional organizations (i.e., the American Cancer Society, the U.S. Preventive Services Task Force, and the American Congress of Obstetricians and Gynecologists) vary somewhat in their recommendations, the overarching message from all three is that health-care professionals are doing Pap smears too frequently. The rationale behind this assertion is that cervical cancer is slow-growing and therefore it can be adequately screened at less frequent intervals than every year. Too-frequent Pap smears lead to many unnecessary procedures and treatments, some of which put women at an increased risk of such pregnancy complications as preterm labor. — Mary Newberry, CNM, MSN (166-1)
These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical question, submit it here.