PAP SMEAR SCREENING IN AN URBAN STD CLINIC - YIELD OF SCREENING AND PREDICTORS OF ABNORMALITIES

Background Pap smear screening studies in STD clinics have reported hi gh rates of squamous intraepithelial lesions (SIL); however, there are limited data on levels of unsatisfactory smears or characteristics as sociated with cytologic abnormalities. Goal: To assess the yield of Pa p smear screening in an STD clinic and to evaluate the rates of and ri sk factors for atypia, low-grade SIL (LSIL), and high-grade SIL (HSIL) . Study Design: A chart review of the clinic records of women undergoi ng Pap smear screening between 1991 and 1994 was conducted. Results we re assessed from two different screening protocols, the first using a Dacron swab to obtain the endocervical sample and the second using a c ytobrush, Results: Of 2034 Pap smears, 1313 (64.6%) were negative, 202 (9.9%) were unsatisfactory, 257 (12.6%) were atypical, 211 (10.4%) ha d LSIL, and 51 (2.5%) had HSIL. With the change to the cytobrush proto col, the rate of unsatisfactory smears decreased from 14.4% to 3% (p < 0.001), atypia increased from 10% to 16.7% (p < 0.001), and HSIL rose from 1.7% to 3.7% (p < 0.001). By multivariate analysis, atypia was a ssociated with genital warts (odds ratio (OR) 1.53, 95% confidence int erval (CI): 1.16-2.02); LSIL with younger age (p < 0.001, for trend), black race (OR 1.51, 95% CI: 1.08-2.10), genital warts (OR 1.81, 95% C I: 1.33-2.37), and an abnormal appearance of the cervix on examination (OR 2.49, 95% CI: 1.85-3.35); and HSIL with a previous abnormal Pap s mear (OR 2.48, 95% CI: 1.08-2.10). Overall, abnormality rates were sig nificantly higher in adolescents (35.5%) than older women (21.7%) (p < 0.01). Conclusions: Obtaining satisfactory Pap smears among women und ergoing screening in an STD clinic is feasible and cytologic abnormali ties are common. These results continue to support the need for Pap sm ear screening in STD clinics, but the high rates in adolescents, a gro up in whom the natural history of cytologic abnormalities has not been web-defined, raise questions about the need to develop age-appropriat e screening and management strategies.