CERVICAL ABNORMALITY AND SEXUALLY-TRANSMITTED DISEASE SCREENING IN HUMAN IMMUNODEFICIENCY VIRUS-POSITIVE WOMEN

Objective: To determine the incidence of genital tract infections and cervical abnormalities in 185 human immunodeficiency virus (HIV)-posit ive outpatients with a view toward establishing an effective policy fo r gynecology screening. Methods: Gynecology results were reviewed for 185 HIV-positive women seen as outpatients at the Royal Free Hospital in London. All subjects underwent screening for cervical abnormalities (smear and colposcopy) and sexually transmitted disease (STD) at 6-mo nth intervals for 6 years. The STD prevalence was calculated, and the relationship between the occurrence of STDs and the demography and sex ual lifestyle of the women was examined to determine whether these fac tors were predictive for women at risk for STDs. The incidence of cerv ical intraepithelial neoplasia (GIN) was determined. We reviewed the u se of colposcopy in addition to cytology as a primary screening test t o see whether it improved the detection rate of CIN. Results: Sixty-fi ve (35.1%) women had a history of previous STDs, and new STDs were det ected in 18 women at their first visits. None were detected at subsequ ent visits. Sexual lifestyle details did not predict women at risk for STDs. Ninety-eight (53%) cervical smears were reported as normal at t he first visit, but there was a 3.1% (95% confidence interval 0, 6.6) false-negative rate when compared with colposcopy and directed biopsy. Five of fifty women (10%) with CIN I had progressed to higher-grade l esions by 6-month follow-up. Conclusions: Given the low prevalence of STDs detected, except for initial screening at presentation, regular, repeat STD screening of HIV-positive women appears to be unnecessary. Because of the high incidence of cervical abnormalities, screening for cervical disease is important, and colposcopy with directed biopsy im proved the detection rate of cervical abnormalities. Copyright (C) 199 7 by The American College of Obstetricians and Gynecologists.