Pap Smears and HPV Vaccine

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It has recently been shown that women with Inflammatory Bowel Disease (IBD) have a higher likelihood of having an abnormal Papanicoloau (Pap) smear than otherwise healthy women. This risk appears to be independent of any medications that a woman is taking as the presence of IBD alone increases the risk. It may be that the factors involved in the abnormalities in the gastrointestinal tract also affect the lining of the cervix. Because of the immunosuppression that women receive to treat their IBD, the risk for an abnormal Pap is even higher. From current research, azathioprine seems to be the medication most related to abnormalities. Infliximab and other biologic therapies may also increase this risk.

Risk factors that can lead to an abnormality in Pap smears like smoking, multiple sexual partners and a family history of cervical cancer still apply to women with IBD. Independent of these risk factors is the use of immune suppressants. The HPV virus, associated with the development of cervical cancer, has been shown to be present in the abnormal Pap smears of those women with IBD. The good news is that the risk of cervical cancer itself does not appear to be any higher. This is probably because those Pap smears that are found to be abnormal are aggressively treated and followed.

In light of these findings, it has been recommended that women who take immune suppressants to control their disease should have Pap smears on a yearly basis, not every 2-3 years as otherwise recommended to women without a history of any abnormal Pap smears. In addition, administration of the HPV vaccine (Gardisil) should be considered. Talk with your doctor about whether you should have the vaccine. Being on immunosuppressants will not affect the effectiveness of the vaccine.

SUMMARY:

• Women with IBD have an increased risk for an abnormal Pap smear.
• Use of immune suppressants increases this risk.
• Yearly Pap smears are recommended to prevent cervical cancer.
• Administration of the HPV vaccine may be appropriate.