Recurrent post-coital bleeding: Should colposcopy still be mandatory?

Area of Science:

• Gynecology
• Oncology
• Virology

Background:

• Recurrent post-coital bleeding (PCB) often leads to colposcopy recommendations.
• Current guidelines suggest colposcopy even with negative cervical cytology or co-testing (oncogenic HPV DNA testing and cytology).

Purpose of the Study:

• To assess the risk of cervical cancer and its precursors in women with recurrent PCB and negative cytology or co-testing.
• To evaluate the utility of human papillomavirus (HPV) testing in managing women with PCB.

Main Methods:

• Retrospective analysis of two cohorts of women with PCB referred for colposcopy.
• Cohort 1 (n=1846): Cytology-based screening (2000-2016).
• Cohort 2 (n=215): Primary HPV screening (2018-2019).

Main Results:

• In Cohort 1, 1 of 1217 women (0.08%) with negative cytology had cancer, and 22 had high-grade squamous intraepithelial lesions (HSIL).
• In Cohort 2, no cancer or HSIL was found in 83 women with negative co-tests.
• The false-negative rate for cytology after negative referral tests was low (2% possibly HSIL or worse on repeat cytology).

Conclusions:

• Women with PCB and negative cytology alone have a low risk of cervical cancer.
• Human papillomavirus (HPV) testing can effectively triage women with PCB, potentially avoiding colposcopy if results are negative and no clinical suspicion for cancer exists.
• Further research with larger cohorts is needed to confirm these findings.