Background/Purpose:

Guidelines recommend screening for cervical cancer in women starting at age 21 but according to the American Congress of Obstetricians and Gynecologists, exceptions should be made for those with HIV and those with weakened immune systems. It is recommended that sexually active adolescents with weakened immune systems should be screened six months apart in the first year after they begin having sex and then continue with annual pap tests. Though studies are limited, it appears that the prevalence of an abnormal Papanicolaou (Pap) smear is significantly increased in patients with SLE. The purpose of this study was to examine pap smear results among SLE adolescent patients at our institution.

Methods:

An IRB approved retrospective chart review was performed on SLE female patients < 21 years. Patients were identified using ICD-9 codes between the years 2000-2016. Sexually active patients with a history of a pap smear were included in the study. Data reviewed included demographics, menarchal status, age of coitarche, contraceptive use, human papillomavirusvirus vaccine (HPV) status, use of immunosuppressive medication and pathology reports. Fisher exact test was used to determine statistical significance.

Results:

18 patients met inclusion criteria. Mean age of SLE diagnosis was 13.6 ± 3.4 years while the average age of menarche was 12.6 ± 1.4 years. All patients were sexually active and the mean age of onset of sexual activity of 16.2 ± 1.8 years, mean age of initial pap smear was 18.4 ± 1.7 years with 44% having a pap smear within the first year of coitarche. Majority were on immunosuppressive medication (94.4%) and 88.9% were on teratogenic medication. Although all utilized progestin-only contraception, only 39% used Long Acting Reversible Contraception and only 39% reported consistent condom use. 83.3% reported ever receiving HPV vaccine.

9/18 (50%) had abnormal pap smears, 4 were atypical squamous cells of undetermined significance (ASCUS) and 5 were Low-grade squamous intraepithelial lesion (LSIL). Plan of care was for repeat pap smear in 1 year in all but one patient with ASCUS pap who underwent a colposcopy with biopsy result of mild chronic endocervicitis and squamous metaplasia. Average age of coitarche was 16 years in both groups. Mean time frame between coitarche to the initial pap smear was 1.66 years and 2.77 years, HPV vaccination rate was 77.8% and 88.8% for those with normal and abnormal pap results respectively. Only 22.2% reported consistent condom use in the abnormal pap smear group compared to 55.6% in the normal pap smear group. Fisher exact test revealed no statistically significant difference (P value 0.1534).

Conclusion:

No high-grade dysplasia on pap smear was noted in this small retrospective study of sexually active adolescent SLE patient. 50% of our sample size had an abnormal pap smear. Despite its limitations and small sample size, this study provides further evidence that women with SLE are at increased risk of developing cervical changes. Larger studies with inclusion of a control group are needed to conclude pap-testing recommendations in the adolescent SLE population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/abnormal-cerviovaginal-cytology-in-adolescents-with-systemic-lupus-erythematosus-a-retrospective-case-series/