Manuel Schydlower

Adolescents with Abnormal Cervical Cytology

Cytologic screening is an important diagnostic tool to detect precancerous and cancerous lesions of the uterine cervix. Cervical intraepithelial neoplasia (CIN) represents a continuum of neoplastic alterations, from mild dysplasia to carcinoma in situ. Our high incidence of 32/1,000 adolescent girls with abnormal cervical cytology, suggestive of CIN, supports studies showing that major cervical pathology does exist in this age group. The importance of this problem, previous experiences, reliability of screening, management, and associated risk factors are reviewed. We advocate that the sexually active older adolescent, 18 to 21, have PAP smears at least yearly. It is also our feeling that sexually active adolescents under 18 should have annual PAP smears, even though our studies revealed a paucity of significantly abnormal findings in this age group.

4 RUBELLA SUSCEPTIBILITY IN AN ADOLESCENT POPULATION: HOW REAL IS THE RISK?

Rubella serology (R-HAI) on 129 adolescents was performed and the response to revaccination of seronegative (<1:8) and low titer (1:8-1:32) subjects was determined (R-IgM, R-IgG).Seventeen percent (18/108) of adolescents with documented rubella vaccination (a mean of 8.3 years before) had no detectable (R-HAI) rubella antibody.Each of 9 previously immunized but seronegative patients developed a R-IgG response following rubella revaccination and no R-IgM response was detected. Each of 12 previously immunized but low titer (1:8-1:32) patients developed a R-IgG response following rubella vaccination and no R-IgM was detected. In contrast, two seronegative subjects who had never previously received vaccine developed R-IgM in their sera two weeks following immunization.The presence of a secondary immune response (R-IgG) despite absence of antibody detectable by R-HAI in previously immunized patients suggests that the R-HAI is an inadequate screening tool. Reimmunization with RA27/3 of 10-11 year old females is recommended until a more satisfactory serologic test is available.