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APGO educational topic number three pap
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smear and DNA probes and culture
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worldwide cervical cancer is the fifth
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leading cause of cancer and the fourth
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leading cause of cancer deaths among
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women in the United States the incidence
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of cervical cancer has decreased by 50
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percent over the last thirty years due
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to increased technology and availability
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of cervical cancer screening the Pap
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test is one of the most effective
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screening tests used in medicine today
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the objectives of this video are to
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describe how to perform a pap smear or
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Pap test describe how to obtain
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specimens to test for sexually
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transmitted diseases and lastly to be
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able to explain the purpose of these
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tests to patients the pap smear or Pap
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test is named after dr. Georges
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Papanicolaou a Greek physician and
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psychologist who discovered that cancer
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could be diagnosed from microscopic cell
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changes his image was featured here on
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the Greek currency let’s spend a day in
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clinic with our gynecologist dr. tess
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Tia de papi
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dr. Pappy is performing a pelvic
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examination on a patient and here is the
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patient cervix
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dr. poppy will use the endocervical
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brush and gynecologic spatula to obtain
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cells from the transformation zone of
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the cervix there are two different
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techniques for pap processing if liquid
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cytology techniques are used the cells
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will be collected in a liquid
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preservative if conventional methods are
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used the cells will be transferred
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directly to a slide thus all samples
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will be stained in a laboratory and read
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by a pathologist for changes associated
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with cervical dysplasia or cervical
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cancer contaminating blood discharge and
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lubrication could interfere with
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specimen interpretation if water-based
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lubrication is used during the speculum
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examination it is important to minimize
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the amount of contact the lubricant has
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with the cervix an advantage of liquid
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based testing that the same sample can
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be used for the Pap test HPV PCR and
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gonorrhea and chlamydia testing although
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gonorrhea and chlamydia testing can be
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performed from the liquid cytology the
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first-line test is nucleic acid
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amplification testing this is a separate
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swab of the endo cervix if a patient is
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not having a pelvic examination
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performed then the nucleic acid
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amplification tests can be performed
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from a urine sample of note this is not
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a clean cat urine but rather a first
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catch urine sample
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so which patients should get tested when
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and for what let’s review some case
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files from a day in clinic with dr.
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poppy
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our first
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patient is I don’t Anita a
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nineteen-year-old gravity zero here for
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her first gynecologic visit I am 19
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years old and have been sexually active
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since age 16 i don’t–i will not need a
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Pap test until age 21 regardless of when
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she first became sexually active it is
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important to discuss contraception and
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to screen for sexually transmitted
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infections women under age 25 should
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have gonorrhea and chlamydia testing at
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least once a year the human
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papillomavirus or HPV is commonly
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contracted by women shortly after
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initiation of sexual intercourse in most
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women the infection is transient and
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does not progress to cervical cancer we
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do not screen for HPV in women under the
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age of 30 because of those two reasons
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and in order to decrease unnecessary
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interventions our second patient is just
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a 1 a 25 year old gravity’ one pair one
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here for her annual examination I had a
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normal cap test three years ago during
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my pregnancy women ages 21 to 30 should
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have a Pap test with cytology only every
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three years since her last Pap test was
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three years ago she is due for one today
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our next patient is HPV two a 50 year
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old gravity’ 2 para 1 coming in for an
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annual examination I have had normal Pap
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tests my whole life women between the
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ages of 30 and 65 should have a Pap test
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with HPV Co testing every 5 years or a
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Pap test with cytology alone every 3
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years remember that even though the Pap
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test is no longer an annual examination
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it is still important to regularly
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perform a bimanual examination and
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visual examination of the external
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genitalia regularly our last patient is
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no need a pap a 68 year-old gravity’ 2
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para 2 here for her annual examination i
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had a hysterectomy and have no history
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of abnormal pap tests women over the age
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of 65 or women who’ve had a total
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hysterectomy no longer need cervical
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cancer screening and will not need Pap
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tests and/or HPV this concludes the
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aapko video on pap smears and DNA probes
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we’ve discussed the function of the Pap
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test
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general testing guidelines and methods
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for obtaining samples