From the Guidelines
For a 63-year-old woman with whitish vaginal discharge, it is appropriate to proceed with a Pap smear as part of cervical cancer screening, given her age is within the recommended screening range, and evaluation of the discharge can be done simultaneously. According to the American Cancer Society's 2020 guideline update 1, individuals with a cervix should undergo primary HPV testing every 5 years through age 65 years, and since this patient is 63, she still falls within the recommended screening age range. The presence of whitish vaginal discharge does not preclude the collection of a Pap smear specimen, as the discharge can be removed with a saline-soaked cotton swab before the test 1.
Evaluation of Vaginal Discharge
The evaluation of the vaginal discharge should include a wet mount, KOH preparation, and vaginal cultures to rule out conditions such as atrophic vaginitis, bacterial vaginosis, or candidiasis, which are common in postmenopausal women even without sexual activity. Urinalysis with urine culture would be indicated only if urinary symptoms are present.
Importance of Simultaneous Evaluation
Addressing both the cervical cancer screening and the symptom evaluation simultaneously is efficient and provides comprehensive care for the patient's concerns. The sequence of cytology testing in relation to the collection of other endocervical specimens does not influence Pap test results or their interpretation 1. Therefore, collecting specimens for the Pap smear first, followed by samples for vaginal discharge evaluation, is a reasonable approach.
Key Considerations
- Cervical cancer screening is recommended for individuals with a cervix through age 65 years 1.
- The presence of vaginal discharge does not postpone cytology testing, and the test can be performed after removal of the discharge 1.
- Evaluation of vaginal discharge should include tests to rule out common conditions in postmenopausal women.
- Urinalysis is only indicated if urinary symptoms are present.
From the Research
Urinalysis and Pap Smear for Elderly Woman
- The patient is a 63-year-old woman presenting with whitish vaginal discharge without sexual intercourse, requesting a Pap smear.
- Considering her symptoms, it is essential to determine whether a urinalysis with urine culture should be performed first.
Relevance of Urinalysis
- A study published in 2022 2 compared the diagnostic value of different urine tests for urinary tract infection, including bacterial culture, urine sediment microscopy, automated urinalysis, and routine urine dry chemical methods.
- The study found significant differences in specificity and sensitivity between these tests, highlighting the importance of selecting the appropriate test for diagnosis.
- Another study from 2022 3 discussed the approaches to and considerations for urinalysis and urine culture reflexive testing, emphasizing the need for evidence-based guidelines and harmonization of practices.
Pap Smear and Urinalysis
- A study from 2020 4 investigated the role of pelvic examination in the evaluation of women with recurrent urinary tract infections and found that it provided contributory information in less than 10% of women.
- However, this study did not directly address the question of whether a Pap smear should be performed concurrently with urinalysis.
- A 2022 study 5 compared urine specimen collection methods for urinalysis and culture agreement, suggesting that catheterized specimens may be preferred over clean catch specimens in certain clinical scenarios.
Decision
- Based on the available evidence, it is unclear whether a urinalysis with urine culture should be performed before requesting a Pap smear for this patient.
- The decision may depend on the patient's specific symptoms, medical history, and clinical presentation, as well as the healthcare provider's professional judgment.