Postcoital bleeding is a predictor for cervical dysplasia.
Adolescent
Adult
Case-Control Studies
Coitus
Colposcopy
Female
Hemorrhage
/ epidemiology
Humans
Incidence
Israel
/ epidemiology
Middle Aged
Papanicolaou Test
Parity
Retrospective Studies
Risk Factors
Uterine Cervical Diseases
/ diagnosis
Uterine Cervical Dysplasia
/ diagnosis
Uterine Cervical Neoplasms
/ diagnosis
Vaginal Smears
Young Adult
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
13
10
2018
accepted:
10
05
2019
entrez:
24
5
2019
pubmed:
24
5
2019
medline:
30
1
2020
Statut:
epublish
Résumé
Postcoital bleeding (PCB) is a common gynecological symptom that may cause concern among both patients and physicians. Current literature is inconclusive regarding management recommendations. To identify risk-factors for dysplasia/cancer among patients presenting post-coital bleeding (PCB). 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. 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). Study results indicate that PCB may require colposcopy, especially for nulliparous women with an abnormal PAP smear.
Sections du résumé
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.
Identifiants
pubmed: 31120980
doi: 10.1371/journal.pone.0217396
pii: PONE-D-18-29724
pmc: PMC6532898
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0217396Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
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