Can a Pap smear be performed during an active bacterial vaginosis infection?

Can a Pap Smear Be Performed During Bacterial Vaginosis?

Yes, a Pap smear can and should be performed during an active bacterial vaginosis infection—the presence of mucopurulent discharge or vaginal infection should not delay cervical cancer screening. 1

Primary Guideline Recommendation

The CDC explicitly states that the presence of mucopurulent discharge should not postpone cytology testing, and the test can be performed after careful removal of the discharge with a saline-soaked cotton swab. 1, 2 This recommendation applies to bacterial vaginosis and other cervical infections. 1

Clinical Approach

Specimen Collection During BV

• Remove visible discharge first: Use a saline-soaked cotton swab to gently remove mucopurulent or excessive discharge from the cervix before collecting the Pap specimen. 1, 2
• Proceed with standard collection technique: Use an extended-tip spatula for the ectocervix/transformation zone with 360° rotation, followed by an endocervical brush rotated 180° in the endocervical canal. 2
• Do not delay screening: Even in the presence of severe cervical infections, cytology tests will typically be reported as satisfactory for evaluation, and reliable final reports can be produced without repeating the test after treatment. 1

When to Consider Repeat Testing

In most instances, repeat cytology after treating BV is unnecessary. 1 However, if specific infections (including BV) are identified and the initial Pap test is reported as "unsatisfactory for evaluation" by the laboratory, a repeat test after appropriate treatment might be indicated. 1 The key distinction is that satisfactory Pap tests do not require repetition simply because an infection was present. 1

Type of Cytology Matters for Timing

While BV itself does not contraindicate Pap testing, menstruation does affect timing differently based on cytology type:

• Conventional cytology: Should be postponed if the woman is menstruating and ideally scheduled 10-20 days after the first day of menses. 1, 3
• Liquid-based cytology: Can be performed at any time during the menstrual cycle, including during menses. 1, 3

This distinction is important because liquid-based cytology offers practical advantages when scheduling is challenging. 3

Evidence on BV Detection via Pap Smear

Research demonstrates that Pap smears can actually detect BV with reasonable accuracy (sensitivity 55-70%, specificity 83-98%), though this is not their primary purpose. 4, 5, 6, 7 However, cytology should never be used as a screening test for STIs or BV—it remains a cervical cancer screening tool. 1 Treatment decisions for BV should be based on appropriate diagnostic tests (Amsel criteria or Nugent score), not cytology findings alone. 8

Common Pitfalls to Avoid

• Do not cancel or postpone Pap appointments simply because the patient has vaginal discharge or diagnosed BV. 1, 2
• Do not skip endocervical sampling due to concerns about infection—the endocervical brush should still be used with standard technique. 2
• Do not assume an "unsatisfactory" result is inevitable—most Pap tests remain satisfactory even with concurrent infections. 1
• Do not treat based on cytology findings of BV alone—use appropriate diagnostic criteria if treatment is indicated. 8