Comparative study of pap smear and polymerase chain reaction tests for human papillomavirus screening in Bahrain.

BACKGROUND: Cervical cancer remains a global health concern, particularly in low- and middle-income countries, including Bahrain, where human papillomavirus (HPV) infection is the leading cause.

AIM: To compare the diagnostic accuracy of cervical cytology (pap smear) and molecular HPV detection using polymerase chain reaction (PCR) in identifying cervical abnormalities among women in Bahrain.

METHODS: We retrospectively analysed 320 pap smear samples from the Salmaniya Medical Complex laboratory. Cytological findings were compared with HPV PCR results, using PCR testing as the gold standard. Sensitivity, specificity, positive predictive value and negative predictive value were calculated. Statistical analyses included chi-square and Fisher's exact tests.

RESULTS: Among the 320 samples, 56 (17.5%) were HPV-positive and 264 (82.5%) were HPV-negative. PCR showed higher sensitivity (95.5%) but had reduced moderate specificity (67.4%), with a positive predictive value for detecting histopathological lesions of 94.6% and a negative predictive value of 96.9%. Pap smears identified 57.5% as negative for intraepithelial lesion or malignancy and 42.5% with abnormalities. HPV-positive cases had higher abnormal cytology rates, and histopathology confirmed lesions in some HPV-positive cases despite normal cytology results.

CONCLUSION: Combining HPV PCR with pap smear enhances cervical cancer detection. Tailored screening programmes based on individual risk factors are recommended to reduce the disease burden.