Diagnosis of Human Papillomavirus Infection by Abnormal Cervical Cytology is Highly Reproducible After Vaginal Douching

SUMMARY 

Objective

To evaluate whether human papillomavirus (HPV) activity in symptomatic patients with abnormal Papanicolaou smears (minimal abnormal cytology) was affected by a complete vaginal douche, applied to the cervix prior to colposcopic examination.

Materials and Methods

A total of 132 women with abnormal Papanicolaou smears were prospectively registered in this study from 1999 to 2004. Two specimens were collected from each patient; one before and one after the cervix was swabbed with a complete vaginal douche during a colposcopic examination. We compared the HPV detection results before and after douching in the same patients. The samples were analyzed using the Hybrid Capture II assay.

Results

Before douching, 57.6% (76/132) of the samples were HPV-positive, compared with 58.3% (77/132) of the samples after douching. There was a strong correlation between the cervical HPV detection rates between the before and after douche samples (p < 0.001). The kappa statistic was 0.891 for the correlation (positive– positive, negative–negative) and the discrepancy (positive–negative) between the inter-douche rates of HPV activity. A comparison of the HPV assay before and after vaginal douching demonstrated a statistically significant relationship (p < 0.001). The sensitivity of the HPV test after douching was higher (97.8%) than that before douching (95.6%). The false-negative rate before douching in women with inflammatory smears was 3% (4/132) and the false-positive rate before douching in women with atypical squamous cells of undetermined significance was 2.1% (3/132).

Conclusion

Our results indicate that self-administration of a vaginal douche is not a reliable method of eradicating HPV infection.

Key Words:  human papillomavirus , Papanicolaou smear , vaginal douche

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