Frequency of cervical intraepithelial neoplasia and infectious agents for vaginitis in menstrual cycle phase.
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Abstract:
The study objective was to verify differences in the diagnosis of infectious agents and CIN in cytological smears in the proliferative and secretory phases of the menstrual cycle.A retrospective study was carried out at the Federal University of "Triângulo Mineiro". Presence of Candida albicans, Trichomonas vaginalis, clue cells, Doderlein bacilli, cytolytic flora, coccoid bacillus, CIN and HPV were collected from the vaginal cytology tests, cervical and endocervical in healthy women of reproductive age from 1994 to 2004 (about 14,000 in total). The cytologies were divided into two groups: proliferative and secretory phase. Chi-square and Fisher's exact tests were used for statistical analysis with the significance level set at less than 0.05.The frequency of cytolysis and candidiasis was higher in the secretory phase of the menstrual cycle (p < 0.0001). When the presence of CIN associated with vulvovaginitis was evaluated, there was no significant difference in cytologies with CIN between the first and the second phases of the menstrual cycle.Frequency of the cytolytic flora and Candida albicans is influenced by the phase of the menstrual cycle, but CIN is not.Keywords:
Vaginal flora
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Objective: To study the incidence of cytolytic vaginosis among patients undergoing cervico-vaginal cytology for vaginal discharge, pruritis, dyspareunia and other symptoms. Cytololytic vaginosis is also known as lactobacillus overgrowth syndrome or Doderlein’s cytolysis. It is characterized by abundant growth of Lactobacilli resulting in lysis of vaginal epithelial cells.
Method: A total of 308 women presented to gynecological OPD. All of the patients were subjected to Pap test with the help of cytobrush. The cervico-vaginal smears were fixed in methanol, stained with papanicolaou stain and studied under microscope independently by two pathologists.
Result: Out of 308 patients, 190 (61.7%) had inflammatory lesion and were negative for intraepithelial malignancy. Out of 190 cases, 31 (16.3%) were diagnosed as cytolytic vaginosis based on clinical and morphological features.
Conclusion: Cytolytic vaginosis is a fairly common entity often misdiagnosed as candidiasis. Morphological features play an important role in identifying cytolytic vaginosis. The results of this study may contribute to reports in the literature indicating the importance of correct diagnosis cytolytic vaginosis leading to appropriate treatment.
Gram staining
Vaginal flora
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Cytolytic vaginosis is a very rare entity that may be clinically misdiagnosed as vulvovaginal candidiasis. The aim of this study was to determine the incidence of cytolytic vaginosis in patients displaying symptoms similar to vulvovaginal candidiasis and to develop a clinicopathological diagnostic and therapeutic approach.In total, 3000 cervical smear samples were evaluated at our center between 2015 and 2018. Patients whose PAP smears demonstrated significant epithelial cytolysis, naked nuclei, excessive increase in lactobacilli population, absent or minimal neutrophils and no microorganisms were subjected to a symptom assessment questionnaire and had their vaginal pHs measured. They were classified into two groups according to their complaints, symptoms and vaginal pHs: Cytolytic vaginosis and Asymptomatic intravaginal lactobacillus overgrowth. A standardized NaHCO3 Sitz bath therapy was applied to the cytolytic vaginosis group.Fifty-three of the patients (1.7%) were diagnosed as cytolytic vaginosis. After Sitz bath therapy, there was a statistically significant decrease in the cytolysis and lactobacillus scores of the patients. Vaginal discharge of 43 (81%) patients ceased completely while that of the remaining 10 (19%) patients decreased after the therapy. The improvement was statistically significant (P < 0.001). There was a complete resolution in 28 (96%) patients with severe; and in 21 (94%) patients with intermediate vaginal discomfort, after the therapy. Dyspareunia was resolved in 35 (97%) patients (P < 0.001).Cytolytic vaginosis is a rare entity that can be diagnosed with the help of cytopathology and has a therapy based on the modulation microbiota by decreasing the vaginal pH.
Vaginal flora
Vaginal discharge
Vaginal disease
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Background and Objectives: It has been suggested that bacterial vaginosis may play a role in the etiology of cervical neoplasia. The authors analyzed the prevalence, risk factors, and impact on histologic changes of bacterial vaginosis in women with cytological abnormalities of the uterine cervix. Methods: Two-hundred-eighty women with dyskaryotic smears were surveyed. Using a questionnaire, data were obtained on smoking habits and sexual history. Bacterial vaginosis was the diagnosis if the vaginal discharge produced a fishy odor upon alkalinization and if clue cells were seen in the wet smear. Cervical scrapes were analyzed for the presence of human papillomavirus DNA, and cervical tissue specimens were analyzed for the presence and severity of (intraepithelial) neoplasia and the proliferation rate (mitotic index) of the lesion. Chlamydia trachomatis was identified by culture of an endocervical swab. Results: Bacterial vaginosis was found in 56 (20%) out of the 280 women. The presence of bacterial vaginosis was significantly associated with the number of cigarettes smoked per day, age at first sexual intercourse, the lifetime number of sexual partners, and current Chlamydia trachomatis infection. The number of cigarettes currently smoked per day and the lifetime number of sexual partners were independent significant risk factors for the presence of bacterial vaginosis. There was no relation between the presence of bacterial vaginosis and the human papillomavirus infection. Bacterial vaginosis did not influence the severity of the (intraepithelial) neoplasia or the mitotic index. Conclusion: In women with dyskaryotic cervical smears, the prevalence of bacterial vaginosis did not seem to be increased, and bacterial vaginosis did not influence the histologic changes. Therefore, bacterial vaginosis is unlikely to be important in the etiology of cervical neoplasia, despite the similarity between its epidemiologic features and those of cervical human papillomavirus infection and cervical neoplasia.
Etiology
Vaginal disease
Vaginal discharge
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Objective To investigate the pathogens in vaginal secretion of 5 446 patients with vaginitis in this region.Methods Sampls of vaginal secretion were collected from patients with vaginitis.Trichomonas and Candida mycoderma were detected by normal saline smear method,and bacterial vaginosis by sialidase technique.Results Of 5 446 samples,the positive was detected in 2 466,the overall detection rate being 45.2%.In which,trichomonas was detected in 123 cases(2.3%),candida mycoderma in 1 417(26.0%),bacterial vaginosis in 1 466(26.9%).Conclusion Simultaneous detection of trichomonas,candida mycoderma and bacterial vaginosis in vaginal secretion can better reflect the pathogen in patients with vaginitis,so as to help clinicians make a correct diagnosis and treatment.
Trichomonas
Vaginal secretion
Trichomonas Vaginitis
Vaginal disease
Etiology
Leukorrhea
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398 symptomatic cases of vaginitis and 43 asymptomatic healthy women were subjected to cervical cytology and microbiological investigations for detection of Bacterial vaginosis, G. vaginalis, T. vaginalis, C. albicans and M. hominis. Cervical inflammatory changes were reported in 81.4% of cases and 60.4% of controls (p < 0.05) and were significantly associated with Bacterial Vaginosis and G. vaginalis infection (p < 0.01). Cervical inflammation was detected in all cases of Trichomonasis.
Gardnerella vaginalis
Trichomonas Vaginitis
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With the aim of evaluating the correlation between dysplastic lesions of the uterine cervix associated or not with condylomatosis and Chlamydia T. infection, we carried out a serological study of anti-Chlamydia species-specific antibodies and a direct and/or a cultural investigation on a sample of 320 women who performed a Pap-test. The serological examination showed positivity (titer greater than or equal to 1:32) in 49 control subjects (with negative cytology) (23.7%); in 27 cases (43.5%) with actual diagnosis of condylomatosis/CIN associated or not with condylomatosis and in 28 cases (54.9%) with previous diagnosis of condylomatosis/CIN associated or not with condylomatosis. The cultural investigation did not show any significant difference among the groups above mentioned. Finally, the frequency of positive cases for anti-Chlamydia antibodies was estimated for each grade of actual or previous CIN: a greater frequency of positivity was noted in cases with CIN 3 (75%).
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Vaginal infections
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Background. Biological pathomorphosis of the leading pathogens of the vaginal microecological system with the occurrence of vulvovaginitis in human papillomavirus (HPV)-associated cervical intraepithelial neoplasia (CIN) is a fundamental prerequisite for optimizing the complex treatment of this disease.
Aim. Optimization of treatment of vulvovaginitis based on the study of the pathomorphism of their pathogens in patients with HPV-associated CIN.
Materials and methods. A two-stage examination of 211 patients with HPV-associated CIN I was carried out from 2013 to 2020. To study the pathomorphosis of the disease, the patients were divided into 2 groups, the 1st group was examined in 20132016, the 2nd in 20172020. The study of microbiocenosis was carried out by RT-PCR using Femoflor-16 reagents. At the second stage, a study of the clinical efficacy of treatment of vulvovaginitis with the complex drug nifuratel 500 mg + nystatin 200 thousand IU (Macmiror Complex) in comparison with metronidazole 500 mg.
Results and discussion. It was revealed that patients with HPV-associated CIN I over the last 8 years have a pathomorphosis of pathogens. In particular, the change in the dominance of anaerobic dysbiosis with the highest bacterial replication of Gardnerella vaginalis in association with Clostridium, Megasphaera spp. and Fusobacterium on the mixed nature of microflora, manifested in the form of vulvaginitis with the dominance of Atopobium vaginae in association with G. vaginalis, Ureaplasma (urealyticum + parvum) and the addition of the intestinal group Enterobacteriaceae spp. and Escherichia coli. The use of the complex drug nifuratel 500 mg + nystatin 200 thousand IU (Macmiror Complex) demonstrated a higher (4 times) clinical efficacy, a 12-fold decrease in the recurrence of the inflammatory process compared with metronidazole in the treatment of vulvovaginitis in patients with CIN I.
Conclusions. 1. The structure of the cervico-vaginal microbiota in HPV-associated CIN I degree is characterized by dysbiotic disorders in 68.3% of cases. During the last 8 years, there was a pathomorphosis of the microecological status from the dominant anaerobic (in 74.2% of cases, =9.39 at p=0.001) to the dominant mixed (in 60.8% of cases, =8.54 at p=0.001 ) with the addition of the intestinal group Enterobacteriaceae spp. and E. coli in 60.8% of patients (=9.59 at p=0.001), which indicated a change in the dominant causative agents of vulvovaginitis in CIN I. 2. Comparative analysis of the clinical efficacy of complex drugs has demonstrated an increase in clinical efficacy when using the drug nifuratel 500 mg + nystatin 200 thousand IU by 4 times, a decrease in the recurrence of the inflammatory process by 12 times, compared with standard therapy with metronidazole, which allows us to recommend inclusion of the drug nifuratel 500 mg + nystatin 200 thousand IU in the therapy of vulvovaginitis in patients with CIN I.
Gardnerella vaginalis
Ureaplasma
Ureaplasma urealyticum
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The aim of this study was to determine the role of Papanicolaou (pap) smears in the diagnosis of lower genital tract infections.A retrospective study was planned by reviewing charts of patients for trichomonas vaginalis, bacterial vaginosis, actinomyces, candida and nonspecific vaginitis.Charts of 9,080 patients were reviewed and 1,733 women had a diagnosis of lower genital tract infection in the pap smear or had had a clinically treated lower genital tract infection. Only 33.5%, 30.4%, 43.3%, and 0% of patients with bacterial vaginosis, trichomonas vaginalis, candida and actinomyces, respectively on pap smear were diagnosed and treated clinically. Postmenopausal patients had a higher rate of trichomonas vaginalis infection and a lower rate of candida infection when compared to women of the reproductive age group. Patients using an intrauterine device for contraception had a statistically significantly increased rate of trichomonas vaginalis and candida infection when compared to women using other contraceptive methods or those who were not using any contraception.Finding trichomonas vaginalis, bacterial vaginosis and actinomyces infections in pap smears might be considered an indication for treatment without performing other diagnostic tests. Treatment of asymptomatic infections can prevent complications in selected patients. Candida can be a commensal bacteria in the vagina, therefore asymptomatic patients may not require treatment. Detection of a higher rate of trichomonas vaginalis and candida infection in IUD users shows that IUDs can increase the risk of vaginal infections and associated complications.
Trichomonas
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The frequency with which clue cells could be detected in Gram-stained vaginal smears and/or cervical Papanicolaou (Pap) smears was compared with the frequency of Corynebacterium vaginale (Haemophilus vaginalis) isolation in a group of 236 female patients, of whom 221 had vaginitis. Vaginal clue cells were found most often in women from whom C. vaginale was isolated (P = 0.00006) whereas, conversely, clue cells in cervical Pap smears were reported more frequently in women with negative cultures for this organism (P = 0.006). C. vaginale isolations were made more frequently from women with both vaginal and cervical clue cells reported (P = 0.000088). However, the combined false positive-false negative vaginal clue cell rate in the patients studied was 36.5%. Neither the detection of vaginal clue cells nor the isolation of C. vaginale was significantly affected by whether or not patients had trichomoniasis (P = 0.25). Trichomonas vaginalis detection in cervical Pap smears and vaginal isolation were related (P = 0.00005), whereas the same relationship was not significant for fungi (P = greater than 0.05).
Trichomonas Vaginitis
Trichomoniasis
Trichomonas
Vaginal smear
Leukorrhea
Isolation
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