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Re: Adolescent pap guidelines From: Joanne Bulley, MD (islesannie@yahoo.com) Thu Oct 26 18:35:16 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: LCLEMOS@aol.com: "Re: Adolescent pap guidelines" Previous message: Danae Steele: "progesterone and preterm labor" In reply to: rmodugno@aol.com: "Re: Adolescent pap guidelines" Next in thread: Henry Gregor: "Re: Adolescent pap guidelines" Reply: Henry Gregor: "Re: Adolescent pap guidelines" >From the recent Pedi and Adol Gyne course I was at (Harvard / Boston Children's and Brig & Women's) ... As the vast majority: over 90% will clear the virus - you do NOT want to know that it is there - so wait to do the pap until 3 years after coital debut. Hence the "don't look because you just want it to run its course" recommendations. The data is pretty convincing. The course materials with references are sitting on my desk at work and I ain't goin' back to get it tonight! Just because we are the US, ACOG put in the "or age 21" with out any data to support it as evidence based med. Having seen the data I am trying to go with the recommendations. But I have also had a 15 yo with CIS and less than 3 yeasr from debut (as far as I could get from her) (along with admissions for chlamydia PID and primary HSV in the 2 months preceeding the Pap) I have a hard time saying "wait 3 years" -- even though the data is very good and I do not want to cut away through biopsies / LEEPS / CKC's if it is mostly going away. I am sure most of us have had patients with such disease and it makes us hesitant to say "no Pap until 3 years after sexual debut or age 21" Joanne At Thu, 26 Oct 2006, rmodugno@aol.com wrote: > >-----Original Message----- >From: agfolley@hotmail.com >To: ob-gyn-l@dns.obgyn.net >Sent: Wed, 25 Oct 2006 6:33 PM >Subject: Re: Adolescent pap guidelines > >  > My take of ACOG is to "leave those kids alone" ie they all have HPV >and most of it will resolve on its own as long as we arent putting our >16-22 year olds through conizations and leeps. How many times have we >seen "abnormal pap,to colpo, leads to leep or conization???" all before >the age of 21? > > >From: "Lynn Montgomery" <apgar10@qwest.net> > >Reply-To: ob-gyn-l@obgyn.net > >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> > >Subject: RE: Adolescent pap guidelines > >Date: Wed, 25 Oct 2006 16:21:40 -0500 > > > >First of all, she is not at "quite low risk for HPV", she is at high >risk > >given that she is sexually active - being recently postpartum. I have > >always adhered to the practice of doing the first pap at age 18 or >when >they > >become sexually active. Given the extremely high number of abnormal >paps I > >see in 14 through 18, I would not want to wait until age 21, and I >live in >a > >"low risk" community. I don't think this has anything to do with >lawyers, > >it has to do with the fact that the prevalence of HPV is very high >and it >is > >our role to apply appropriate screening to assure that cervical >lesions > >don't go undetected. > >Lynn > > > >I agree with Andrew, Lynn. Since moving to NC, I have seen numerous >adolescents/teens referred to me for colposcopy from the surrounding >county health departments (NC is well known for their excellent county >health departments). > >Yes, they are at risk for HPV, but not necessarily for high- risk >strains?- what is the natural course of the disease - and how many of >these young women are going to be subject to procedures that jeopardize >the integrity of the cervix? Ofcourse you are aware of the recent >studies questioning the role of LEEP as a cause of premature delivery. > >We need less destructive methods to treat CIN - where is the cervical >equivalent of Aldara? The 3M rep can't tell me lest they lose their >job. > >Robert Modugno MD MBA FACOG >Sylva, NC > >(Recently saw a 40+ year old patient with stage IIIB cervical cancer- >the usual stage of presentation where I trained in South Africa - was >DES exposed - had not had a pap smear for years.) > >across the web, free AOL Mail and more. > -- Joanne Bulley, MD Keene, NH, USA Next message: LCLEMOS@aol.com: "Re: Adolescent pap guidelines" Previous message: Danae Steele: "progesterone and preterm labor" In reply to: rmodugno@aol.com: "Re: Adolescent pap guidelines" Next in thread: Henry Gregor: "Re: Adolescent pap guidelines" Reply: Henry Gregor: "Re: Adolescent pap guidelines"

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