Cytological abnormalities

If a woman presents for STI testing or genital examination, a Pap smear should be taken if one has not been carried out within the recommended time period. If there is obvious inflammation, consider delaying the smear until it is resolved. Trichomoniasis is sometimes only diagnosed on cytological smears. Therefore, it is useful to include a posterior pool of vaginal secretion as well as samples from the ectocervix and endocervix on the slide. The slide needs to be sprayed with fixative within 20 seconds of the sample being taken in order to prevent air-drying artefact.

Documentation of the Pap smear results in the patient's notes, and active follow-up of abnormal smears, is very important. Recommendations as to when the smear should be repeated are generally given in the report. If the cervix appears abnormal, or there are two consecutive abnormal smears with atypical cells, or there is evidence of high-grade dysplasia (cervical intra-epithelial neoplasm [CIN] II/III), the patient should be referred for colposcopy. Testing for human papilloma virus (HPV) may be useful in the management of cervical abnormalities.

Pregnancy

Medicines in pregnancy.