Cytology and high-risk human papillomavirus testing to reduce colposcopies in women with postcoital bleeding

INTRODUCTION. Women with postcoital bleeding (PCB) are traditionally referred for colposcopy. A 2022 regional strategy recommends colposcopy only if abnormalities are found in cytology, human papillomavirus testing or by gynaecological examination (GE). This study explores the number of reduced colposcopies using this triad to detect precancerous or cancer lesions and examines the potential for implementing this strategy with general practitioners (GPs). METHODS. Between 1 January 2022 and 15 October 2024, a retrospective cohort study was conducted on women referred with PCB identified using the International Classification of Diseases, tenth version (ICD-10) diagnosis codes "DN930 Bleeding after coitus" and "DN930B Contact bleeding". Data were collected from the hospital's electronic patient files and the Danish Pathology Database. RESULTS. Data from a total of 392 patients were analysed. Among 199 low-risk patients with normal tests, 161 (81%) avoided colposcopy. The combined sensitivity of cytology and hrHPV tests was 97%, detecting 33 of 34 CIN2+ cases. One CIN2+ case was missed by both tests but identified by GE. GP agreed with gynaecologists in 53% of abnormal GE findings, whereas 47% were misclassified as normal GE findings. CONCLUSIONS. Combining cytology, hrHPV testing and GE reduces unnecessary colposcopies in low-risk women with PCB by 81%. The triadic approach successfully identified all CIN2+ cases. Implementing the new strategy with GPs is challenging due to GPs' limited accuracy in identifying abnormal GE findings. FUNDING. None. TRIAL REGISTRATION. Not relevant.