Human papillomavirus testing

doi:10.1136/bmj.323.7304.109

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Authors' comments

Gemma Rebello, consultant cytopathologist,
Nick Hallam, consultant virologist,
George Smart, consultant gynaecologist,
David Farquharson, patient services director, reproductive medicine,
Jane McCafferty, colposcopy sister

Colposcopy Clinic, Royal Infirmary of Edinburgh, Lothian University Hospitals NHS Trust, Edinburgh EH3 9YW
Regional Clinical Virology Laboratory, City Hospital, Lothian University Hospitals NHS Trust, Edinburgh EH10 5SB
Colposcopy Clinic, Royal Infirmary of Edinburgh
Epidemiology Group, Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen AB25 2ZD

EDITOR—In This Week in the BMJ of 14 April our study of human papillomavirus testing and the management of women with mildly abnormal cervical smears is described as an NHS pilot1; it was not. In the accompanying editorial Manos expressed surprise that we advised caution in the clinical use of this test despite evidence for its role in managing women with borderline cervical smears.2 We intended the context of our advice to be that of our paper: the management of women with borderline or mildly dyskaryotic smears.

As we stated, although there is evidence from the United States that human papillomavirus testing is useful in triaging the equivalent of borderline change, such testing has limited potential in triaging the equivalent of mild dyskaryosis (because of high positivity for papillomavirus (83%)).3 Caution would seem reasonable if these two types of mild abnormality are being considered together (as in the NHS pilot scheme based in England) rather than separately (as in the United States). We were disappointed that Manos's editorial said little …