Undiagnosed sexually transmitted diseases are a major health epidemic in the world.  Some of the worst ones have no symptoms.  The cervical cancer screening pap smear has been updated with new genetic technology to identify bioth gonorrhea and chlamydia- two of the most serious dangers.

The standard pap smear is a decades old technology where a doctor wipes the cervix (or mouth of the womb inside the vagina) with a brush and sends the cells to a lab.  There, they are examined for precancerous or cancerous cells.  Pap Smears save lives from cervical cancer.  In the last 50 years, it has helped reduce the number of cervical cancer deaths from 35,000 a year to less than 5,000 today.

The first imprevment in the pap smear- thin prep:  A major improvement came with the development of liquid based , or thin-prep, technology.  Here the cells are collected into a fluid that is processed through proprietary machinery to remove the often overwhelming background debris that can hide the cancerous cells.  It is becoming a standard with some estimates of more than 85% of doctors using it.

(The evolution of this technology and the company behind it will be the topic of an upcoming review here at DITM)

What’s New: Hidden Sexually Transmitted Disease (STD) Screening:  STD’s are  major health crisis.  Two of the most common in the USA (chlamydia and gonorrhea) are often asymptomatic in women.  Unfortunately, these hidden STDS are major causes of internal scarring and infertility in women.  In advanced cases each pelvic infection episode dramatically increases the risk of infertility with almost half of women with three episodes developing tubal infertility.  As Gen-probe reports the problem is severe especially in young women and teens:

Each year, close to four million cases of chlamydia and one million cases of gonorrhea occur in the United States. In fact, up to half of patients diagnosed may be infected with both … therefore, it is important to test all sexually active individuals for both…  Further, the complications that can result from untreated chlamydia and gonorrhea can be serious. Recent CDC recommendations call for expanded chlamydia testing. It is recommended that all sexually active adolescent women be screened for chlamydia at least once a year. Close to half (46%) of chlamydia cases occur in women ages 15-19 and another one third (33%) of infections occur in females between the ages of 20-24. Young individuals are also at an increased risk for gonorrhea. In fact, seventy-five percent (75%) of all reported cases occur in individuals between the ages of 15 to 29 years.

How does it work?:  This test is based on genetic nucleic acid technology.  That is, after the cancer screening part is done the sample is tested for the STD infection’s unique DNA.  It is close to 98% sensitive in picking up  these hidden diseases.

(technical explanation:  The APTIMA COMBO 2 Assay is a second generation nucleic acid amplification test that uses target capture for in vitro qualitative detection and differentiation of rRNA from CT and GC. The assay uses a family of Gen-Probe’s proven technologies including target capture (TC), Transcription-Mediated Amplification (TMA) and Dual Kinetic Assay (DKA). This is the same family of technologies used to screen the nation’s blood supply.)

Now that the FDA has cleared this test to be combined with the pap smear it is possible that millions of women could be screening with one test for these hidden dangers.

For extensive information on STD’s from the CDC read here.

An amazing resource for information on the STD epidemic and its devastating effects on fertility are at the American Society for Reproductive Medicine’s Protect Your Fertility Campaign.  Here is a white paper on the epidemiology of the infections and the effects on fertility.