THE MANAGEMENT OF PATIENTS WITH INFLAMMATORY SMEAR RESULTS IN GENERAL-PRACTICE

Object-To ascertain the management of inflammatory smear results by general practitioners. Design-Postal questionnaire survey. Subjects-All 200 general practitioners on Wirral Family Health Services Authority list as principals in 1990 and 1991. Main outcome measures-Answers to questions covering a variety of aspects concerning the management of inflammatory smear results in general practice. Results-One hundred and thirteen (57%) replied. Ninety per cent have facilities to test for Trichomonas vaginalis and Candida albicans. Sixty eight per cent were able to test for Chlamydia trachomatis. A high vaginal swab (HVS) was the commonest swab taken (88%); 31% of doctors included a swab for Chlamydia trachomatis. Of doctors who gave treatment without microbiological confirmation 74% gave metronidazole and 64% gave tetracycline or erythromycin. Eighty five per cent repeat smears are undertaken within three months. Ninety seven per cent of doctors said more detailed information would be helpful on the cytology report. One hundred per cent of doctors referred to a gynaecologist if colposcopy was advised. Male sexual partners were advised to attend the Department of Genitourinary Medicine by 12% of doctors (70% do not refer to either their general practitioner or genitourinary department). Conclusion-Most patients with inflammatory smear results are managed by their general practitioner without reference to specialist services. Many patients are not investigated for infection but treatment often includes medication which covers the most likely or potentially serious genital pathogens. More detailed advice given with the cytology report on further management or a local protocol would be helpful to aid management in this difficult area. If recommendations for referral of certain groups of patients to genitourinary departments were implemented the present workload of the department would be increased.