Tekstra, F.M. (2025) Reconsidering colposcopy in young women with post-coital bleeding and normal cervical cytology: limited clinical benefit in a retrospective cohort. thesis, Medicine.
Full text available on request.Abstract
Background: Since the 2016 revision of the Dutch Society of Obstetrics and Gynaecology (NVOG) guideline on cervical intraepithelial neoplasia (CIN), the number of colposcopies performed has increased, including those for post-coital bleeding (PCB). PCB incidence is highest among women aged 20-29 years. However, the clinical value of colposcopy in young women with normal cervical cytology (Pap1) remains unclear. This study evaluates the relevance of colposcopy in women aged 20-29 years with PCB and normal cervical cytology. Methods: This retrospective cohort included patients who underwent colposcopy for PCB between January 2017 and December 2024 at the Martini Hospital, Groningen, the Netherlands. Data on patient characteristics, cytology, colposcopy, histology, treatment, and follow-up were collected from medical records. The primary outcome was detection of high-grade intraepithelial lesions (HSIL). Secondary outcomes included follow-up findings and the influence of high-risk human papillomavirus (hrHPV). Results: One out of 258 patients (0.4%) was diagnosed with CIN2 on histology. The negative predictive value of normal cytology was 99.6%. After a median follow-up of 55 months, data were available for 120 patients. Four patients (3.3%) developed HSIL, one (0.8%) squamous cell carcinoma, and all tested hrHPV-positive. Smoking was significantly associated with the development of ≥CIN2 (OR10.1, 95%CI 1.1-91.9, p=0.027). Conclusion: HSIL is rare in young women with PCB and normal cervical cytology, routine referral for colposcopy should be reconsidered. Conservative management in primary care, including testing for sexually transmitted infections, silver nitrate treatment, and hrHPV co-testing after 12 months of PCB, appears justified. Colposcopy is indicated when hrHPV-positive.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Woolderink, Dr. J.M. and Kleppe, Dr. M. |
| Faculty: | Medical Sciences |
| Date Deposited: | 11 May 2026 12:35 |
| Last Modified: | 11 May 2026 12:35 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3949 |
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