From the Guidelines
If a Pap smear result is normal except for the presence of inflammation, it is recommended to treat the underlying cause of the inflammation.
Key Considerations
- The patient should be evaluated for an infectious process, and if specific infections are identified, re-evaluation should be performed after appropriate treatment, preferably after 2-3 months 1.
- A follow-up Pap smear should be obtained within 3 months to rule out any underlying cervical abnormalities 1.
- The patient should be advised to practice good hygiene, avoid douching, and use condoms to reduce the risk of future infections.
- If the inflammation persists or worsens, a repeat colposcopy or biopsy may be necessary to rule out any underlying conditions.
Treatment Options
- Anti-inflammatory medication such as ibuprofen 400mg three times a day for 5-7 days may be prescribed to reduce inflammation.
- Antibiotics such as metronidazole 500mg twice a day for 7-10 days or clindamycin 300mg twice a day for 7-10 days may be necessary if the inflammation is suspected to be caused by a bacterial infection.
Follow-up Care
- A follow-up Pap smear should be obtained in 6-12 months to ensure the inflammation has resolved and to rule out any underlying cervical abnormalities 1.
- Patients with a history of abnormal Pap smears or those who are at high risk for cervical cancer should be considered for more frequent follow-up and colposcopic evaluation 1.
From the Research
Significance of Inflammation on Pap Smear
- The presence of inflammation on a Pap smear, even with normal results, may indicate an underlying infection or cervical abnormality 2, 3, 4.
- Studies have shown that women with persistent inflammation on Pap smear are at a higher risk of having cervical intraepithelial neoplasia (CIN) 2.
- Inflammation on Pap smear can be caused by various factors, including bacterial vaginosis, and may not always be a reliable predictor of infection in asymptomatic women 3, 4.
- The predictive value of inflammation on Pap smear for infection is relatively low, with one study showing a positive predictive value of only 7% for Chlamydia and 14% for Trichomonas 4.
Clinical Implications
- Women with persistent inflammation on Pap smear may require further evaluation with colposcopy and directed biopsy if necessary 2.
- The presence of inflammation on Pap smear does not appear to be a risk factor for preterm delivery, unlike bacterial vaginosis 5.
- Inflammation on Pap smear may not be a reliable surrogate for more specific diagnosis of bacterial vaginosis 5.
- Clinical guidelines may need to be revised to take into account the significance of inflammation on Pap smear, particularly in cases of persistent inflammation 2, 6.