Post-coital bleeding (PCB) is a disturbing gynecological symptom that may be a concern for both patient and physician, and its reported prevalence varies from 0.7%-9% among menstruating women. PCB may reflect different benign conditions such as infectious morbidities, but can also indicate the presence of cervical cancer . Colposcopy has been suggested as the appropriate investigation tool required for ruling out cervical cancer, or other pre-malignant pathologies; however the literature is not decisive in the management recommendations.
The objective of this study was to evaluate the role of PBC in predicting cervical pathology.
A cross-sectional study using the computerized database of HMO encompassing 2 million insured patients. The research was approved by the local REB committee (number 25/2106). All of PCB cases were identified through a computerized query relating to the years 2012-2016. Further, patients’ records in a single center were investigated and the following variables were assessed: age, marital status, ethnical background, gravity, parity, BMI, smoking, socio-economic status, past history of cervical pathology, PAP smear result and colposcopy evaluation. Colposcopy reports were reviewed for findings, required biopsy and biopsy results. For the purpose of this study we included non-pregnant patients between 18- 50 years.
Incidence/100,000 patients during the study period ranged 326.1-565.9 cases/year. Among investigated records, mean age was 32±7.9 years, mean BMI: 24.0±4.3, 53% were married, 49.1% gave birth, 17% were smoking and 18.7% presented with a background medical diagnosis. 8% of PCB cases had an abnormal PAP smear in the preceding year. All sample cases went through a colposcopy by a single practitioner; 201 (48.9%) requiring a biopsy. Biopsy results were as following: 44 (21.9%) normal tissue, 25 (12.4%) cervical polyp, 68 (33.8%) cervicitis, 61 (30.3%) HPV- related/CIN 1/condylomas, 2 (1.0%) CIN-2/3 and 1 case (0.5%) of carcinoma. The positive predictive value for HPV- related pathology was 15%, and for high-grade lesions (CIN-2/3 and carcinoma): 0.7%. In a multivariate logistic regression analysis, parity and the presence of a pathological PAP smear (P value 0.02, OR 0.39 and P value 0.01, OR 3.3 respectively) were significantly related to HPV-related cervical pathology.
PCB is a common gynecological complain with relatively high prevalence of HPV- related pathologies. Although high grade lesions are rare, we recommend considering colposcopic evaluation in those women.