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This image was created using molecular modelling software and data from cryo-electron microscopy. Licence fees: A licence fee will be charged for any media (low or high resolution) used in your project. The Papanicolaou test (abbreviated as Pap test, known earlier as Pap smear, cervical smear, or smear test) is a method of cervical screening used to detect potentially pre-cancerous and cancerous processes in the cervix (opening of the uterus or womb).
A Pap smear is performed by opening the vaginal canal with a speculum, then collecting cells at the outer opening of the cervix at the transformation zone (where the outer squamous cervical cells meet the inner glandular endocervical cells). Women should wait a few years after they first have intercourse before they start screening, and should not be screened before age 21. Most people who contract HPV do so soon after becoming sexually active.[3][citation needed][dead link] It takes an average of a year, but can take up to four years, for a person's immune system to control the initial infection.
Pap smear screening is still recommended for those who have been vaccinated against HPV,[9] since the vaccines do not cover all of the HPV types that can cause cervical cancer. More frequent Pap smears may be needed to follow-up after an abnormal Pap smear, or after treatment for abnormal Pap or biopsy results, or after treatment for cancer.
Estimates of the effectiveness of the United Kingdom's call and recall system vary widely, but it may prevent about 700 deaths per year in the UK. Since the population of the UK is about 61 million, the maximum number of people who could be receiving Pap smears in the UK is around 15 million to 20 million (eliminating the percentage of the population under 20 and over 65). As liquid based preparations (LBPs) become a common medium for testing, atypical result rates have increased. Endocervical and endometrial abnormalities can also be detected, as can a number of infectious processes, including yeast, herpes simplex virus and trichomoniasis.
Micrograph of a Pap test showing a low-grade intraepithelial lesion (LSIL) and benign endocervical mucosa. Pap tests can usually be performed during pregnancy up to at least 24 weeks of gestational age.[24] Pap tests during pregnancy have not been associated with increased risk of miscarriage.
Obtaining a pap smear should not cause much pain,[28] but it can if the person has certain untreated vaginal problems such as cervical stenosis or vaginismus, or if the person performing it is too harsh, or uses the wrong size speculum. Yet it's not comfortable, for two reasons which work together: the cervix is full of nociceptors,[29] and the brush used to collect cells has to be stiff enough to scrape them off of the surrounding tissue. People with underlying pain or tissue diseases that can react to nociceptors (pain nerves) being scraped or to excessive cold in the mucous membranes should take appropriate precautions and discuss the process ahead of time with their providers, in writing if necessary. Many health care providers are under the false impression that only sterile water, or no lubricant at all, should be used to lubricate the speculum. The health care worker begins by inserting a speculum into the woman's vagina, which spreads the vagina open and allows access to the cervix. The sample is stained using the Papanicolaou technique, in which tinctorial dyes and acids are selectively retained by cells. In some cases, a computer system may prescreen the slides, indicating those that do not need examination by a person or highlighting areas for special attention.
For other cervical screening tests and Human Papillomavirus testing, see Cervical screening. Conventional Papa€”In a conventional Pap smear, samples are smeared directly onto a microscope slide after collection. Liquid based cytologya€”The sample of (epithelial) cells is taken from the Transitional Zone; the squamo-columnar junction of the cervix, between the ecto and endocervix. In addition, Human Papilloma Virus (HPV) test may be performed either as indicated for abnormal Pap results, or in some cases dual testing is done, where both a Pap smear and HPV test are done at the same time (also called Pap co-testing).
The endocervix may be partially sampled with the device used to obtain the ectocervical sample, but, due to the anatomy of this area, consistent and reliable sampling cannot be guaranteed.
The test was invented by and named after the prominent Greek doctor Georgios Papanikolaou who started his research in 1923. Papanicolaou's name was repeatedly submitted to the Nobel Committee and rejected every time. In the developed world, cervical biopsy guided by colposcopy is considered the "gold standard" for diagnosing cervical abnormalities after an abnormal pap smear. In Taiwan most middle and upper-class people have access to the Pap test and can choose to have one done annually. The finding of coccoid bacteria on a pap test is of no consequence with otherwise normal test findings and no infectious symptoms.


Boulware LE, Marinopoulos S, Phillips KA, Hwang CW, Maynor K, Merenstein D, Wilson RF, Barnes GJ, Bass EB, Powe NR, Daumit GL (2007). Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, Garcia FA, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ER (2012). You are called to see a 1-year-old boy admitted to the hospital for treatment of an atypical teratoid rhabdoid tumor of the brainstem. Surface swabs initially were performed and showed negative herpes simplex virus and varicella zoster virus via PCR, negative candida screen, and no growth from a surface wound culture.
Aspergillus fumigatus is found in the environment and may cause opportunistic fungal infections. Cutaneous infection with Aspergillus can present in many ways, including as eschar, hemorrhage, ulcerative nodules, papules, cellulitis and sporotrichoid nodules. The differential diagnosis includes bacterial infection, Staphylococcus aureus being the most likely bacteria, or viral infection with HSV or VZV due to the grouped nature of the papules. If there is suspicion for infection with Aspergillus, skin biopsy is imperative and should include tissue for both routine microscopy and fungal culture. Aspergillus infection in the skin can be primary (direct inoculation) or secondary (hematogenous spread, likely from primary lung or sinus infection). Early identification of cutaneous fungal infections in immunocompromised patients is critical.
Is it ethical to use genetically modified mosquitos to prevent transmission of vector-borne diseases? Cryo-electron microscopy uses multiple angled beams of electrons to image specimens kept at minus 150 degrees Celsius. Abnormal findings are often followed up by more sensitive diagnostic procedures, and, if warranted, interventions that aim to prevent progression to cervical cancer. The person may also be referred for HPV DNA testing, which can serve as an adjunct to Pap testing. American Congress of Obstetricians and Gynecologists (ACOG) and others recommend starting screening at age 21 (since that is a few years after initial sex for most American women).[2][13] Many other countries wait until age 25 or later to start screening.
Screening during this period may show this immune reaction and repair as mild abnormalities, which are usually not associated with cervical cancer, but could cause the person stress and result in further tests and possible treatment. About one-quarter of US cervical cancers were in people that had an abnormal Pap smear, but did not get appropriate follow-up (person did not return for care, or clinician did not perform recommended tests or treatment).
A medical practitioner performing 200 tests each year would prevent a death once in 38 years, while seeing 152 people with abnormal results, referring 79 for investigation, obtaining 53 abnormal biopsy results, and seeing 17 persisting abnormalities lasting longer than two years. This would indicate that the use of Pap smear screening in the UK saves the life of 1 person for every approximately 20,000 people tested (assuming 15,000,000 are being tested yearly). However it is not very sensitive at detecting these infections, so absence of detection on a Pap does not mean absence of the infection.
However, Pap smears can be performed during a person's menstrual period, especially if the physician is using a liquid-based test; if bleeding is extremely heavy, endometrial cells can obscure cervical cells, and it is therefore inadvisable to have a Pap smear if bleeding is excessive. So it can be uncomfortable, but it's generally quick, and the information obtained may be critical.
A smaller speculum, lidocaine gel, and warming the instruments and lubricant ahead of time, along with extra time in the exam room and gentle technique, can all contribute to reducing the risk to manageable levels. The spotting is usually from the scrape on the cervix and the diarrhea may be due to indirect stimulation of the lower intestine during the exam.
The health care provider then collects a sample of cells from the outer opening or os of the cervix by scraping it with an Aylesbury spatula.
The broom is not as good a collection device, since it is much less effective at collecting endocervical material than the spatula and brush.[31] The broom is used more frequently with the advent of liquid-based cytology, although either type of collection device may be used with either type of cytology. The sample is then usually screened by a specially trained and qualified cytotechnologist using a light microscope. As abnormal endocervical cells may be sampled, those examining them are taught to recognize them. Cells may exfoliate onto the cervix and be collected from there, so as with endocervical cells, abnormal cells can be recognised if present but the Pap Test should not be used as a screening tool for endometrial malignancy. The Nobel Committee delegated the in-depth investigation of Papanicolaou's merits and demerits to the late Professor Santesson, who was at that time the head of pathology at the Stockholm Cancer Institute (the Radiumhemmet). However, if there is enough inflammation to obscure the detection of pre-cancerous and cancerous processes, it may indicate treatment with a broad-spectrum antibiotic for streptococci and anaerobic bacteria (such as metronidazole and amoxicillin) before repeating the smear.


Candidal infection can present with red papules, but the distribution of few fixed papules on one extremity is uncommon; more typically you would see scattered red papules or pustules that would spread and have satellite lesions without treatment.
Hematoxylin and eosin stains often will show necrotic tissue with inflammation due to the angioinvasive nature of the fungus, and occasionally may highlight organisms. Given the myriad presentations of cutaneous Aspergillus, the index of suspicion should be high when examining immunocompromised patients at risk for developing such infections. Coughlin, MD, is a pediatric dermatology fellow at The Children’s Hospital of Philadelphia.
The infection may lead to the development of small and painful blisters known as fever blisters or cold sores. The test aims to detect potentially pre-cancerous changes (called cervical intraepithelial neoplasia (CIN) or cervical dysplasia; the squamous intraepithelial lesion system (SIL) is also used to describe abnormalities), which are caused by human papillomavirus, a sexually transmitted DNA virus. Cervical cancer usually takes time to develop, so delaying the start of screening a few years poses little risk of missing a potentially precancerous lesion.
If only 10,000,000 are actually tested each year, then it would save the life of 1 person for every approximately 15,000 people tested. A number of studies have shown that using a small amount of water-based gel lubricant does not interfere with, obscure, or distort the PAP smear. Papanicolaou chose stains that highlighted cytoplasmic keratinization, which actually has almost nothing to do with the nuclear features used to make diagnoses now. The terminology for who screens the sample varies according to the country; in the UK, the personnel are known as cytoscreeners, biomedical scientists (BMS), advanced practitioners and pathologists. The cells taken are suspended in a bottle of preservative for transport to the laboratory, where using Pap stains it is analysed. The oncology team plans to start IV and intrathecal chemotherapy, but calls you first to evaluate a red plaque on the patient’s left arm that has been present and stable since his transfer. This patient was at risk for two reasons: possible occlusion of the area with tape while IV placement was attempted at the outside hospital, and immunosuppression from prednisone in a patient with a tumor. The lack of scale, lack of small surrounding papules, and lack of current contactant made irritant or allergic contact dermatitis less likely in this particular case. Fungal stains typically will show the organisms that appear as hyphae with acute-angle branching and frequent septations, usually highlighted with Gomori methenamine silver staining. When possible, urgent excision of a single lesion or few localized foci is recommended, as excision can prevent distant spread if performed quickly. The test remains an effective, widely used method for early detection of pre-cancer and cervical cancer. The cells are placed on a glass slide and taken to the laboratory to be checked for abnormalities. The latter two take responsibility for reporting the abnormal sample which may require further investigation. The nucleus in koilocytes is typically irregular, indicating possible cause for concern; requiring further confirmatory screens and tests.
At this point, these techniques have not been validated by large-scale trials and are not in general use. It does not appear to be symptomatic, but the patient’s mental status is altered from his tumor.
Infection of an IV puncture site or of skin occluded with a dressing around an IV is typical of this uncommon infection. Tissue culture is key in confirming the diagnosis and identifying the exact species of Aspergillus. Systemic antifungal treatment is advisable as an adjunctive treatment for localized disease, and as primary treatment for systemic disease or in patients with localized disease not amenable to primary excision.
While the test may also detect infections and abnormalities in the endocervix and endometrium, it is not designed to do so.
Extremities, as well as the head and neck, are more often affected than other parts of the body. Upon further questioning, you learn that IV placement was attempted in that location at the outside hospital.



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