The cervical smear pattern in patients with chronic pelvic inflammatory disease

Abstract

Background: Cancer of the cervix is the commonestmalignancy of the genital tract inNigeria. In an atmosphere of opportunistic screening due to lack of a national screening programme, studies are needed to determine patients at risk of premalignant lesions of the cervix. Goal: To determine cervical smear pattern in patients with chronic pelvic inflammatory disease and investigate the potential of chronic pelvic inflammatory disease as a risk factor to cervical dysplasia. StudyDesign: Case- control study. Setting : Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital Zaria, Nigeria. Subjects: Three hundred and sixty-nine premenopausalwomen attending the gynaecologic and family planning clinics ofAhmaduBelloUniversity TeachingHospitalZaria,Nigeria fromJanuary toDecember 2000. Results: Of the 369 women that had cervical cytology by Pap smear, 163 (44%) had chronic pelvic inflammatory disease (cases) while 206 (56%) were non chronic PID patients (control). There was no statistical significance in the mean age between the two groups. The mean age at first coitus and marriage of all the womenwere 17.92.7 years and 18.5 3.4 years respectively.Therewere 52 dysplastic smears encountered, giving a prevalence rate of 140/1,000 or 14% for Cervical Intraepithelial Neoplasia. There were higher cases of dysplasia in the chronic PIDgroup than in the control and this differenceswas statistically significant (p<0.05). Other risk factors to dysplasia identified include high parity (>4) and age of first coitus less than 20 years. Only 10%of all thewomen screenedwere aware of both cervical cancer and Pap smear. Conclusion: Women with chronic pelvic inflammatory disease are probably at higher risk of developing cervical dysplasia than women without chronic pelvic inflammatory disease.Cervical cancer screening programmes should be intensified in chronic pelvic inflammatory disease patients.However, further studies are needed in our setting to verify the association between pelvic inflammatory disease and cervical dysplasia.

Keywords:  Cervical smear, pelvic inflammatory disease, cervical cancer