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. 2020 Dec;60(6):952-958.
doi: 10.1111/ajo.13247. Epub 2020 Sep 10.

Recurrent post-coital bleeding: Should colposcopy still be mandatory?

Jeffrey H J Tan  1   2 , Yasmin L Jayasinghe  1   2 , Margot J Osinski  1 , Julia M L Brotherton  3 , C David H Wrede  1   2
Affiliations

Recurrent post-coital bleeding: Should colposcopy still be mandatory?

Jeffrey H J Tan et al. Aust N Z J Obstet Gynaecol. 2020 Dec.

Abstract

Background: Colposcopy has been recommended for all women with recurrent post-coital bleeding (PCB) even if their cervical cytology or co-test (involving oncogenic human papillomavirus (HPV) DNA testing and cytology) are negative.

Aims: To determine the risk of cervical cancer and its precursors among women with recurrent PCB with negative cytology or co-test.

Materials and methods: A retrospective analysis of two cohorts of women with PCB referred to a tertiary colposcopy clinic. Cohort (1) (n = 1846) between 1 January 2000 and 31 December 2016 (cytology-based screening) and Cohort (2) (n = 215) from 1 January 2018 to 31 December 2019 after introduction of primary HPV screening.

Results: In 1217 (65.9%) women in Cohort (1) referred with negative cytology, there was one cancer (0.08%) and 22 high-grade squamous intraepithelial lesions (HSIL (cervical intraepithelial neoplasia 2/3)) on histopathology. In Cohort (2), there was no cancer or HSIL in 83 women with negative co-tests (negative for oncogenic HPV and cytology). False-negative cytology after a negative referral cytology or co-test was low with 2% of repeat cytology at initial colposcopy showing possible HSIL or worse.

Conclusions: Women presenting with PCB and negative cytology alone have a low risk of cancer and could have HPV testing before being triaged to colposcopy. We showed that with the assurance of a negative co-test and the low likelihood of false-negative cytology, these women could avoid colposcopy unless cervical cancer is clinically suspected. There is a need for a larger cohort study to substantiate our findings with more precision.

Keywords: cervical cancer; co-testing; colposcopy; cytology; post-coital bleeding.

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References

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