The prevalence of abnormal pap smear in women with pelvic inflammatory disease and determine the risk factors of cervical intra-epithelial neoplasia 2/3

Abstract

Objective: To investigate the prevalence of abnormal Pap (ASCUS or worse) and HPV infection in women with pelvic inflammatory disease (PID) and assess the risk factors for CIN2/3. Methods: Retrospective chart review of 249 women who were admitted to the hospital for the treatment of PID between 2013 and 2019 was performed. Patients’ characteristics including age, parity, sexually transmitted disease (STD) infection, Pap results, human papilloma virus (HPV) infection, Nugent score, C-reactive protein (CRP), and neutrophil to lymphocyte ratio (NLR) were retrieved. Clinical characteristics were compared between group 1 (women with normal pap; N = 159) and group 2 (women with abnormal Pap; N = 90). Results: Of 249 women, abnormal Pap rate was 36.1% and HPV positivity was 41.0%. Of those with HPV infection, 78.4% had high-risk HPV subtypes. Group 2 was significantly associated with high-risk HPV infection (P < 0.0001) and low NLR (P = 0.047). 74 women underwent colposcopy-directed punch biopsy, and 14 showed CIN2/3. Multivariate analysis showed that high-risk HPV infection (P = 0.040; 95% CI 1.081-32.389) and low Nugent score (≤ 3) (P = 0.003; 95% CI 2.130-39.807) were independent risk factors of CIN2/3 in women with abnormal Pap and PID. Conclusions: Women with PID showed high prevalence of abnormal Pap. Nonetheless, high-risk HPV infection and low Nugent score are the most reliable factors in determining colposcopy for the diagnosis of CIN2/3.