Can a pap smear be performed when someone has a sexually transmitted infection (STI)?

Performing Pap Smears in Patients with Sexually Transmitted Infections

Yes, a Pap smear can be performed when someone has a sexually transmitted infection (STI), and in most cases, the presence of an STI should not delay cervical cancer screening. 1

General Principles for Pap Smears with STIs

The CDC's sexually transmitted infections treatment guidelines provide clear direction on this matter:

• The presence of an STI is not a contraindication for Pap testing
• Pap tests are not effective screening tests for STIs 1
• Most STIs do not interfere with the reliability of Pap test results

Management Approach

When to Proceed with Pap Testing Despite STIs

• Mucopurulent discharge: Can be carefully removed with a saline-soaked cotton swab before performing the Pap test 1
• External genital warts: Do not require more frequent Pap smears than recommended for routine screening 1
• Most cervical infections: Even with severe infections, Pap tests will typically be reported as "satisfactory for evaluation" 1

When to Consider Postponing Pap Testing

• Menstruation: If a woman is menstruating, conventional cytology Pap tests should be postponed 1
• Severe cervicitis: Some experts recommend deferring until after antibiotic therapy, though this is not strictly necessary in most cases 1

Procedural Considerations

1. Specimen collection sequence: The sequence of Pap testing in relation to collection of other cervicovaginal specimens does not influence Pap test results 1
2. If STIs are identified: In most cases, there is no need to repeat the Pap test after treatment for those infections 1
3. Follow-up: If specific infections are identified during a Pap test, reevaluation after appropriate treatment may be indicated in some cases, though this is not routinely necessary 1

Special Situations

Pregnant Women with STIs

• Pregnant women should receive cervical cancer screening at the same frequency as non-pregnant women 2
• A cytobrush can be used for obtaining Pap smears in pregnant women, with care taken not to disrupt the mucous plug 2

HIV-Infected Women with STIs

• HIV-infected women should have more frequent cervical cancer screening due to their increased risk of cervical abnormalities 1
• The presence of STIs does not change this recommendation

Common Pitfalls to Avoid

1. Delaying necessary screening: Postponing Pap tests due to STIs may result in missed opportunities for early detection of cervical abnormalities
2. Confusing screening purposes: Remember that Pap tests screen for cervical cancer/precancer, not STIs 1
3. Unnecessary repeat testing: In most cases, Pap tests do not need to be repeated after STI treatment 1
4. Improper specimen collection: When mucopurulent discharge is present, careful removal before sampling improves specimen quality 1

Clinical Decision Algorithm

1. Is the patient menstruating?

   • Yes → Postpone conventional Pap test
   • No → Proceed to next step

2. Is severe mucopurulent discharge present?

   • Yes → Carefully remove discharge with saline-soaked cotton swab before proceeding
   • No → Proceed with Pap test

3. After Pap test collection:

   • Collect specimens for STI testing if indicated
   • Treat identified STIs according to guidelines
   • No need to repeat Pap test after STI treatment in most cases

By following these evidence-based guidelines, providers can ensure appropriate cervical cancer screening while managing STIs effectively, optimizing both patient convenience and clinical outcomes.