An open-label randomized trial to determine the most effective regimen of vaginal estrogen to reduce the prevalence of atrophic changes reported in postmenopausal cervical smears.

OBJECTIVE: Atrophic Papanicolaou (Pap) smears from postmenopausal women may be unsatisfactory for assessment or result in a false-positive diagnosis of a cytological abnormality. We investigated the effect of vaginal estrogen treatment before the Pap test on the odds of an atrophic smear. METHODS: An open-label randomized controlled trial was conducted to compare the proportion of atrophic Pap smears from postmenopausal women assigned to either (1) a regimen of one 25-microg vaginal estradiol tablet inserted nightly for five nights before their Pap test, (2) a single 25-microg vaginal estradiol tablet before the test, or (3) a control group with no previous estrogen administration. All smears were reread and classified as atrophic or nonatrophic at the conclusion of the study by a single cytopathologist who was blinded to the study arms. RESULTS: One hundred fifty-four (94%) of the 164 postmenopausal women who consented to the study were included in the final analysis. Fifty-one women had received the five-night course of tablets, 50 had received one tablet, and 53 were assigned to the group with no previous estrogen use. The odds of an atrophic smear were significantly lower in women who used the five-night estrogen regimen than in women who did not use estrogen. The estimated odds ratio of an atrophic smear in the five-night regimen was 0.01 (95% CI, 0.03-0.26) compared with the no-estrogen control group. Moreover, using one tablet of estrogen had no significant effect on the likelihood of an atrophic smear compared with using none. The odds ratio of an atrophic smear in the single estrogen tablet group was 1.05 (95% CI, 0.48-2.29) compared with the no-estrogen group. CONCLUSIONS: The odds of an atrophic smear are significantly reduced for postmenopausal women who use a five-night regimen of vaginal estrogen before their Pap test.

Marrying research, clinical practice and cervical screening in Australian Aboriginal women in western New South Wales, Australia.

INTRODUCTION: Research shows that Australian Aboriginal women experience a significantly higher rate of mortality from cervical cancer than non-Aboriginal women. We now understand that infection with human papillomavirus (HPV) is a necessary pre-requisite for cervical cancer. This knowledge, together with the development of prophylactic vaccines against the HPV types most commonly associated with cervical cancer (16 and 18), made it vital to gain nationally representative HPV genotyping data for Australian women, including Aboriginal and Torres Strait Islander women. A research project, the 'Women, Human papilloma virus prevalence, Indigenous, Non indigenous, Urban, Rural Study' (WHINURS) was designed to obtain the HPV status of Aboriginal and non-Aboriginal women when they presented for their routine cervical screen. Family Planning NSW (FPNSW), an organisation that had previously worked in community based projects to increase Aboriginal participation in cervical screening, provided an investigator site in western NSW with the intention to recruit 50 Aboriginal women and 100 non-Aboriginal women. METHODS: The method was a consultative approach, including national and local frameworks for Aboriginal and Torres Strait Islander recruitment. The FPNSW Dubbo team devised a series of strategies to maximise recruitment when this did not progress according to plan. Strategies were developed to meet this challenge, including street walks, attendance at community forums, flexible appointments, drop-in times and assistance with travel and babysitting. RESULTS AND CONCLUSION: As a result of the activities listed above, 43 women were recruited to WHINURS, just seven short of the target. Collaborative community-based consultation, as well as the research study itself increased the number of Aboriginal women accessing cervical screening at the family planning clinic. This was sustained a year after the conclusion of the study.

Chlamydia trachomatis infection in the family planning clinical setting across New South Wales.

BACKGROUND: Following a small pilot study in 2003, a study was set up to determine the prevalence of genital Chlamydia trachomatis infection in young women presenting to Family Planning NSW centres across New South Wales and to evaluate the characteristics of those infected. METHODS: A cross-sectional survey of 621 consecutive women aged from 16 to 24 years was carried out over a 3-month period in 2004 at five Family Planning NSW centres. Urine samples were tested for C. trachomatis using the polymerase chain reaction (PCR) method. Women with a positive result were reviewed and treated. RESULTS: Of 925 eligible clients, 621 (67%) were recruited to the study. Chlamydia trachomatis was detected in 35 of the 621 recruits (5.6%, 95% CI 3.8-7.4). The prevalence at the Hunter centre was significantly higher than the combined prevalence at the other four participating centres (9.7% compared with 3.9%; P = 0.008). Two characteristics were identified as independent predictors of infection in this study: 'reporting a recent change ofpartner in the past three months' (crude odds ratio (OR) 3.33, 95% CI 1.67-6.64) and 'reporting three or more partners in the past year' (crude OR 3.69, 95% CI 1.83-7.46). Reported condom use, a history of one or more sexually transmissible infections and current combined oral contraceptive pill use were not associated with infection in this study. CONCLUSIONS: The prevalence of C. trachomatis infection is sufficiently high to support targeted testing of 16-24-year-old women in the Family Planning NSW setting and informs the development of a national screening strategy.