Study: Risk of urinary tract infection increases after a pap smear

Dr Jeffrey Tiemstra, Dr Patricia Chico, and Emily Pela conducted research to determine if the incidence of urinary tract infection increased following a pap smear and pelvic examination. Urinary tract infection (UTI) is a common clinical condition, especially for women. It is calculated that at least one third of women in the United States will be diagnosed with a UTI before the age of 24, and the lifetime risk for UTI is estimated to be 60.4% (Griebling, 2005).

Sexual intercourse is strongly associated with incidence of UTIs (Moore et al., 2008). The mechanisms for increased risk of UTI due to sexual intercourse include “propulsion of bacteria up the urethra into the bladder; microtrauma to the urethra and bladder mucosa, allowing bacterial adhesion; and alteration of normal flora” (Tiemstra, Chico, & Pela, 2011, p. 296).

A pelvic examination, including speculum insertion and insertion of fingers into the vagina, involves similar mechanisms. Given the similar mechanisms between intercourse and a pelvic exam, the researchers presumed that a pap smear and pelvic exam may increase risk of UTIs in the same manner as sexual intercourse.

A total of 1582 women participated in the study. The researchers investigated the frequency of UTIs and other genitourinary problems following the study participant’s pap smears and pelvic exams. The researchers found that UTIs and other urinary complaints were significantly more frequent during the first 7 weeks after a pap smear compared with weeks 8 to 14, 8 to 48, and 8 to 52. The study also revealed that Candidal and bacterial vaginitis was slightly more frequent during the first 7 weeks after a pap and pelvic exam compared with weeks 8 to 48 and 8 to 52.

Given the increased frequency of UTIs following a pap smear and pelvic exam, the researchers make a number of recommendations that include:

  • eliminating the bimanual exam during pap smear screening
  • adherence to guidelines for less frequent pap smear screening in low-risk women
  • self-sampling techniques that avoid speculum insertion should be given more consideration

The full study can be viewed here: https://www.jabfm.org/content/24/3/296.long#ref-1

Resources

Griebling, T. L. (2004). Urinary tract infections in women. In: Litwin MS, Saigal CS, eds. Urologic diseases in America. NIH publication no. 04–5512. US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, DC: US Government Publishing Office: 153–183.

Moore, E. E., Hawes, S. E., Scholes, D., Boyko, E. J., Hughes, J. P., & Fihn, S. D. (2008). Sexual intercourse and risk of symptomatic urinary tract infection in post-menopausal women. Journal Of General Internal Medicine, 23(5), 595–599.

Tiemstra, J. D., Chico, P. D., & Pela, E. (2011). Genitourinary infections after a routine pelvic exam. The Journal of the American Board of Family Medicine, 24(3), 296-303.

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