4 e-Letters

published between 2019 and 2022

  • Author response to 'Concerns about high grade HPV results on routine smear tests'.

    Thank you for your e-letter 'Concerns about high grade HPV results on routine smear tests' which we read with interest. You highlight some important questions that women have following receipt of an HPV positive result, such as where the infection came from and the consequences of HPV for partners. We identified similar issues in our recently published review exploring the psychosexual impact of testing positive for high-risk HPV (1). We acknowledge the importance of training and advice for all clinicians involved in cervical screening so they are able to confidently support and reassure women who test positive for HPV. Public Health England (PHE) have developed an e-learning module on primary HPV testing to support clinicians (2), and Jo’s Cervical Cancer Trust has information for practice nurses and GPs on HPV and cervical screening (3), which clinicians may find helpful.

    (1) Bennett KF , Waller J , Ryan M, Bailey JV & Marlow, LAV (2019). The psychosexual impact of testing positive for high‐risk cervical human papillomavirus (HPV): a systematic review. Psycho-oncology;28:1959–1970. doi.org/10.1002/pon.5198

    (2) Public Health England (2019). Primary HPV screening training resources launched. Available from: https://phescreening.blog.gov.uk/2019/02/11/primary-hpv-screening-traini...

    (3) Jo's Cervical Cancer Trust (2016). Inform...

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  • Concerns about high grade HPV results on routine smear tests.

    I read with interest this article. I am a GP with many years of experience in Sexual Health. Our area has over the past months started to implement the HPV screening tagged on to the conventional liquid based cytology. As a GP with interest in SH, I am doing the 'difficult' smears in our practice, either for women who found the smear taking particularly awful - due usually to dryness, and vaginal atrophy, but also for other reasons, such as opportunistic smear taking in women fearful of smears. Recently one of the smears I had taken contained an unexpected high grade HPV infection, in a woman in her early fifties. In the light of this, I felt I had no choice but to take a sexual history - a potential minefield in General Practice. In this particular case, the patient had been in a monogamous relationship for 30 years, having one daughter in her early twenties. This at least told me I won't have to do an HIV and syphilis test (but, maybe she should?). Positive high grade HPV results do bring up of lot sensitive issues, and questions, especially for women, such as, where did this come from? how long have I had it? What are the repercussions in my relationship? Might there be a risk of violence following a result like this? Will women feel they have to keep it secret from their partners for fear of being blamed? What may be the consequence of high grade HPV for the partner? It is no good just ignoring these issues, or doing it off as a perso...

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  • Supplementary vs Table 2 data

    As an interested observer from a different field, I am not an expert in the statistical analysis techniques used in this article. However, it appears from the supplementary data table that the lowest rate of cancer for women is actually for either 1 partner (against which the others are compared and all are >1 OR) or 5-9 partners with an OR of 1.28, based on the categories presented, but the 0 partner case has an OR of 1.81. This supplementary data table therefore does not support the conclusion "A higher lifetime number of sexual partners is associated with increased odds of reported cancer" and does not warrant the comment in the paper that no differences were found.

  • Regular Contraception user requests declined over the 5 years - another reflection of reduced access to sexual health clinics and GPS?

    Thank you for the above article. It was noted that over the 5 year period the percentage of consultations for patients who used regular contraception compared with no regular method reduced by a statistically significant amount ( 44.2% to 33.9% p <0.001). A possible explanation for this could be reduced access to clinics and Primary Care in Wales, as England with pressures on all health services. I would welcome any moves in my area of Wales for CPs to provide oral hormonal contraception.