Psychosexual distress following routine primary human papillomavirus testing: a longitudinal evaluation within the English Cervical Screening Programme

Abstract

Objective: To assess psychosexual distress over a 12-month period among women receiving different human papillomavirus (HPV) and cytology results in the context of the English HPV primary screening pilot. Design: Longitudinal, between-group study. Setting: Five sites in England where primary HPV testing was piloted. Population: Women aged 24–65 years (n = 1133) who had taken part in the NHS Cervical Screening Programme. Methods: Women were sent a postal questionnaire soon after receiving their screening results (baseline) and 6 and 12 months later. Data were analysed using linear regression models to compare psychosexual outcomes between groups receiving six possible combinations of HPV and cytology screening results, including a control group with normal cytology and no HPV test. Main outcome measures: Psychosexual distress, assessed using six items from the Psychosocial Effects of Abnormal Pap Smears Questionnaire (PEAPS-Q). Results: At all time points, there was an association between screening result group and psychosexual distress (all P < 0.001). At baseline, mean psychosexual distress score (possible range: 1–5) was significantly higher among women with HPV and normal cytology (B = 1.15, 95% CI 0.96–1.34), HPV and abnormal cytology (B = 1.02, 95% CI: 0.78–1.27) and persistent HPV (B = 0.90, 95% CI 0.70–1.10) compared with the control group (all P < 0.001). At the 6 and 12 month follow ups the pattern of results were similar, but coefficients were smaller. Conclusions: Our findings suggest receiving an HPV-positive result can cause psychosexual distress, particularly in the short-term. Developing interventions to minimise the psychosexual burden of testing HPV-positive will be essential to avoid unnecessary harm to the millions of women taking part in cervical screening. Tweetable abstract: Receiving an HPV-positive result following primary HPV testing can cause psychosexual distress, particularly in the short-term.