From the Guidelines
A repeat Pap smear is recommended within 3 months when results show reactive squamous cells and acute inflammation, as suggested by the 1993 guidelines from the Centers for Disease Control and Prevention 1. This recommendation prioritizes the timely follow-up of potential abnormalities while allowing the inflammation to resolve. The presence of reactive squamous cells with acute inflammation typically indicates a benign, inflammatory process rather than a precancerous condition.
- Possible causes of inflammation include:
- Infections such as bacterial vaginosis, trichomoniasis, or yeast
- Physical irritation
- Recent intercourse If symptoms of infection are present, treating the underlying cause with appropriate antibiotics or antifungals before the repeat Pap is advisable.
- Treatment options may include:
- Metronidazole 500mg twice daily for 7 days for bacterial vaginosis
- Fluconazole 150mg single dose for yeast infections It's essential to note that persistent inflammation can sometimes mask more significant cellular changes, which is why follow-up is crucial even though these findings are usually benign.
- Further evaluation with colposcopy may be necessary if the repeat Pap continues to show inflammation or reactive changes, as indicated by the guidelines 1.
From the Research
Repeat Pap Smear Guidelines
- The decision to repeat a Pap smear after receiving results showing reactive squamous cells and acute inflammation depends on various factors, including the patient's medical history and previous Pap smear results 2.
- According to a study published in 2001, most cases of benign cellular changes (BCC) on Pap smears are due to reactive and inflammatory processes, and in patients with no significant prior cervical abnormalities, a Pap smear classified as BCC represents a reactive process 2.
- However, in patients with a previous history of cervical intraepithelial neoplasia (CIN), BCC may be of some significance, and a repeat Pap smear may be necessary to monitor for potential recurrence 2.
Management of Atypical Squamous Cells
- For patients with atypical squamous cells (ASCUS) on Pap smear, the management options include repeat Pap smear or human papillomavirus (HPV) triage testing 3.
- A study published in 2008 found that women's preferences for alternative managements of ASCUS on Pap smear varied, with some preferring immediate HPV testing and others preferring repeat Pap smear 3.
- Another study published in 2005 suggested that reflex HPV-DNA testing may be useful in managing patients with ASCUS, particularly those with ASC-H (atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion) 4.
Inflammation and Repair on Pap Smear
- Inflammatory conditions, such as cervicitis and vaginitis, can cause reactive changes in cervical cytology specimens, which may mimic precancerous or cancerous lesions 5.
- A study published in 2022 emphasized the importance of recognizing reactive and hyperplastic cell morphology in cytology specimens, as these changes can overlap with neoplastic changes 5.
- The study also highlighted the need for cytologists to inform clinicians about the presence of specific pathogens, even if identification of these pathogens is not always relevant from a clinical point of view 5.