From the Guidelines
Reactive cellular changes on a Pap smear should be managed by treating any underlying infection and advising the woman to have another Pap smear within 3 months, as recommended by the Centers for Disease Control and Prevention 1. These changes are often benign alterations in cervical cells that occur in response to inflammation, infection, or irritation. The primary concern is to address any underlying cause, such as bacterial vaginosis, yeast infections, trichomoniasis, or physical irritation from intrauterine devices or recent sexual activity.
- Common causes of reactive cellular changes include:
- Bacterial vaginosis
- Yeast infections
- Trichomoniasis
- Physical irritation from intrauterine devices or recent sexual activity
- Treatment of underlying infections may involve:
- Antifungals like fluconazole for yeast infections
- Metronidazole for bacterial vaginosis or trichomoniasis
- Antibiotics for bacterial infections Follow-up care, as suggested by the Centers for Disease Control and Prevention, should include a repeat Pap smear within 3 months if severe inflammation with reactive cellular changes is present 1. This approach prioritizes the early detection and management of any potential underlying conditions that may impact morbidity, mortality, and quality of life.
From the Research
Reactive Cellular Changes on Pap Smears
- Reactive cellular changes on Pap smears are a common finding, accounting for 92% of benign cellular changes cases 2.
- These changes are often due to reactive and inflammatory processes, and in patients with no significant prior cervical abnormalities, a Pap smear classified as reactive cellular changes represents a reactive process 2.
- However, in patients with a previous history of cervical intraepithelial neoplasia (CIN), reactive cellular changes may be of some significance 2.
Risk of CIN2-3 and Cancer
- Women with reactive cellular changes on their cervical smear face an increased risk of CIN2-3, but not a significant increased risk of cancer 3.
- The probability of CIN2-3 was increased in the reactive cellular changes group as compared with the group of women with a normal smear (0.7% versus 0.5%, p=0.002) 3.
- Multivariate analyses showed that, compared with a normal cervical smear, reactive cellular changes were associated with a significant 37% increased risk of CIN2-3 (HR=1.37 CI95 [1.13-1.66]) 3.
HPV Testing and Reactive Cellular Changes
- HPV testing can help identify women at high risk for developing high-grade CIN or cancer 4, 5.
- The addition of an HPV test to the Pap test to screen women for cervical cancer reduces the incidence of grade 2 or 3 CIN or cancer detected by subsequent screening examinations 4.
- However, the sensitivity and specificity of HPV testing and Pap smears can vary, and a proficient combination of the tests is likely to result in the most satisfactory clinical practice in the management of women with abnormal Pap tests 5, 6.