DIAGNOSIS OF HUMAN PAPILLOMAVIRUS INFECTION BY ABNORMAL CERVICAL CYTOLOGY IS HIGHLY REPRODUCIBLE AFTER VAGINAL DOUCHING

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 11 assay. Results: Before couching, 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 couching 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. [Taiwan J Obstet Gynecol 2008;47(4):412-416]