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Gonullu DC, Huang XM, Robinson LG, Walker CA, Ayoola-Adeola M, Jameson R, Yim D, Awonuga A. Tubal factor infertility and its impact on reproductive freedom of African American women. Am J Obstet Gynecol 2022; 226:379-383. [PMID: 34111406 DOI: 10.1016/j.ajog.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 11/17/2022]
Abstract
In the past, the reproductive freedom of African American women was hindered by forced reproduction and sterilization campaigns. Unfortunately, these involuntary practices have now mostly been replaced by inequality because of disproportionate tubal factor infertility rates within African American communities. Our work aimed to describe the inequities in increased rates of pelvic inflammatory disease and tubal factor infertility as it relates to African American women. In addition, we highlighted the need for improved access to screening and treatment of sexually transmitted infections, access to barrier contraception, and health literacy related to the understanding and prevention of tubal factor infertility in African American women.
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Affiliation(s)
- Damla C Gonullu
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI.
| | - Xiao M Huang
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - LeRoy G Robinson
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY
| | - Christopher A Walker
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Martins Ayoola-Adeola
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Rebecca Jameson
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Dorothy Yim
- Wayne State University School of Medicine, Detroit, MI
| | - Awoniyi Awonuga
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
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Grosse A, Grosse C, Lenggenhager D, Bode B, Camenisch U, Bode P. Cytology of the neovagina in transgender women and individuals with congenital or acquired absence of a natural vagina. Cytopathology 2017; 28:184-191. [DOI: 10.1111/cyt.12417] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2016] [Indexed: 12/21/2022]
Affiliation(s)
- A. Grosse
- Institute of Clinical Pathology; University Hospital Zurich; Zurich Switzerland
| | - C. Grosse
- Department of Pathology; Kepler University Hospital; Linz Austria
| | - D. Lenggenhager
- Institute of Clinical Pathology; University Hospital Zurich; Zurich Switzerland
| | - B. Bode
- Institute of Clinical Pathology; University Hospital Zurich; Zurich Switzerland
| | - U. Camenisch
- Institute of Clinical Pathology, Diagnostic Molecular Pathology; University Hospital Zurich; Zurich Switzerland
| | - P. Bode
- Institute of Clinical Pathology; University Hospital Zurich; Zurich Switzerland
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Cervical cytopathological findings in Korean women with Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum infections. ScientificWorldJournal 2014; 2014:756713. [PMID: 24526918 PMCID: PMC3910385 DOI: 10.1155/2014/756713] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 10/22/2013] [Indexed: 11/17/2022] Open
Abstract
This is to investigate the cervical cytological abnormalities associated with Chlamydia trachomatis, Mycoplasma hominis, Mycoplasma genitalium, and Ureaplasma urealyticum infections on routine screen. A total of 714 subjects who had undergone cervical Pap smears and concomitant analyses for cervical infections were included by a retrospective search. The frequencies of reactive cellular change (RCC) and squamous epithelial abnormalities were significantly higher in Chlamydia positive subjects than in uninfected subjects (P<0.001). Of the 124 subjects tested for M. hominis, M. genitalium, and U. urealyticum, 14 (11%) were positive for M. hominis and 29 (23%) were positive for U. urealyticum. Squamous abnormalities were more frequent in subjects with Ureaplasma infections than in uninfected subjects (24% versus 8%). Taking together these findings, C. trachomatis and U. urealyticum may have a causal role in the development of cervical epithelial changes, including RCC. Thus, extra awareness is warranted in cervical screening of women with Chlamydia or Ureaplasma infections.
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López-Olmos J, Gasull J. Infección vaginal por tricomonas (e infecciones mixtas) y atipias celulares, en la citología cervicovaginal. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2011. [DOI: 10.1016/j.gine.2010.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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5
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Weyers S, Lambein K, Sturtewagen Y, Verstraelen H, Gerris J, Praet M. Cytology of the ‘penile’ neovagina in transsexual women. Cytopathology 2010; 21:111-5. [DOI: 10.1111/j.1365-2303.2009.00663.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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6
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Paçarada M, Lulaj S, Kongjeli G, Kongjeli N, Qavdarbasha H. Factors associated with pathologic colposcopic and cytologic changes in 500 clinically asymptomatic women. Int J Gynaecol Obstet 2009; 108:7-11. [DOI: 10.1016/j.ijgo.2009.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 07/04/2009] [Accepted: 08/20/2009] [Indexed: 10/20/2022]
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7
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Donnellan NM, Wiesenfeld HC. Inflammation on liquid-based cervical cytology: can leukocytes be used to triage for Chlamydia trachomatis testing? Am J Obstet Gynecol 2007; 196:e33-5. [PMID: 17466673 DOI: 10.1016/j.ajog.2006.10.910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Revised: 10/04/2006] [Accepted: 10/31/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The study was undertaken to investigate whether leukocytes on liquid-based cervical cytology can predict Chlamydia trachomatis infection. STUDY DESIGN A retrospective case-control study of females under 30 years examined the association between leukocytes on liquid-based cervical cytology and C. trachomatis infection. RESULTS Smears from chlamydia-infected women had an average of 30.7 leukocytes and a median of 25.4 leukocytes per high-powered field (hpf), whereas smears from controls had an average of 11.5 leukocytes and a median of 7.1 leukocytes per hpf. The median leukocyte to epithelial cell ratio among infected women was 1.4 vs 0.6 in the controls (P < .05). No clear cutpoint of leukocytes to epithelial cells was identified that could serve to detect the maximal number of infected women while minimizing the testing of uninfected women. CONCLUSION There is an association between inflammation on liquid-based cervical cytology and C. trachomatis infection. However, assessing for leukocytes cannot be recommended as a triage for chlamydia screening, as there is great overlap in inflammation among infected and uninfected women.
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Affiliation(s)
- Nicole M Donnellan
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Eckert LO, Thwin SS, Hillier SL, Kiviat NB, Eschenbach DA. The antimicrobial treatment of subacute endometritis: a proof of concept study. Am J Obstet Gynecol 2004; 190:305-13. [PMID: 14981366 DOI: 10.1016/j.ajog.2003.09.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Our purpose was to evaluate the antimicrobial therapy effect on clinical and laboratory findings among women at risk for endometritis. STUDY DESIGN A prospective antimicrobial treatment trial of 153 women was performed to characterize subacute endometritis and to determine the treatment effect on endometritis resolution. RESULTS After antimicrobial treatment, significant reductions occurred in abnormal bleeding (60% vs 29%), mucopurulent cervicitis (20% vs 6%), uterine tenderness (20% vs 6%), and histologic endometritis (38% vs 4%), all P<.001. In women with prior pelvic inflammatory disease (PID), endometritis was present in 43% with and 28% without current Chlamydia trachomatis or Neisseria gonorrhoeae. In women without prior PID, endometritis was present in 23% with and 12% without current C trachomatis or N gonorrhoeae (P=.002 for trend). CONCLUSIONS In women without a clinical diagnosis of PID, antimicrobial therapy decreased abnormal clinical findings and histologic endometritis. Prior PID is additive with current cervical infection as a risk for endometritis.
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Affiliation(s)
- L O Eckert
- Departments of Obstetrics and Gynecology and Pathology, University of Washington, Seattle, WA, USA
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Anorlu RI, Abdul-Kareem FB, Abudu OO, Oyekan TO. Cervical cytology in an urban population in Lagos, Nigeria. J OBSTET GYNAECOL 2003; 23:285-8. [PMID: 12850863 DOI: 10.1080/01443610310000100114] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Eight hundred and eighty-four consecutive women had cervical smears in a clinic in Lagos, Nigeria between September 1998 and 31 August 1999. Mean age was 36.6 - 11.6 years (range 16-81 years); 93.7% were first-time screening. Three hundred and twenty-five (36.5%) smears were normal, inflammatory smears 52.7%, mild dyskaryosis 2.4%, moderate dyskaryosis 1.5%, severe dyskaryosis 0.3% and probable malignancy (malignant cells) 0.8%. Abnormal smears were higher in symptomatic cases compared with asymptomatic cases (chi2=15.3, P< 0.01); 6.1% and 2.1% of symptomatic cases had dyskaryosis and carcinoma, respectively, compared with 3.4% and 0.1% for asymptomatic cases. In postcoital bleeding 9.3% and 1.9% had dyskaryosis and carcinoma, respectively. Fifty-six of 62 cases of cervical erosion had abnormal smears. In postmenopausal bleeding 13.0% and 4.3% had dyskaryosis and carcinoma, respectively. Prevalence of abnormal cervical smears is high in women who have genital tract disease. In places with no national screening programmes every effort should be made to screen such women.
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Affiliation(s)
- Rose I Anorlu
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria.
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10
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Abstract
Cervicitis encompasses a variety of gynecologic conditions. Although inflammation on a Papanicolaou smear may be indicative of true cervical inflammation, establishing a diagnosis of mucopurulent cervicitis (MCP) is more clinically useful. MCP seems to be analogous to nongonococcal urethritis in men. Many cases of MCP are related to Chlamydia trachomatis infection, but the majority of cases have other potential causes. Other possible pathogens include Neisseria gonorrhoeae, Trichomonas vaginalis, Ureaplasma urealyticum, Mycoplasma genitalium, herpes simplex virus, and cytomegalovirus. Many cases may be related to cervical ectopy. MCP is a marker for endometritis, salpingitis, and adverse pregnancy outcomes. Given the current shortcomings in our understanding of this disease, an empiric approach to evaluation and treatment is suggested.
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Affiliation(s)
- Paul Nyirjesy
- Associate Professor of Obstetrics and Gynecology and Medicine (Infectious Diseases), Jefferson Medical College, 834 Chestnut Street, Suite 400, Philadelphia, PA 19107, USA.
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Paler RJ, Simpson DR, Kaye AM, Gunn S, Felix JC. The relationship of inflammation in the papanicolaou smear to Chlamydia trachomatis infection in a high-risk population. Contraception 2000; 61:231-4. [PMID: 10827338 DOI: 10.1016/s0010-7824(00)00094-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Chlamydia trachomatis is a significant etiologic agent responsible for pelvic inflammatory disease leading to tubal infertility. A screening test aimed at identifying women at risk for Chlamydia trachomatis would be of great utility. The Papanicolaou smear is the most widely used screening test in the world. The association of inflammatory cells in the Papanicolaou smear to Chlamydia infection is controversial. We retrospectively examined the Papanicolaou smears of 80 Chlamydia-negative patients with 80 age-matched Chlamydia-positive patients in a high-risk population to see if a significant difference in inflammation was noted between the two groups. We found a statistically significant difference in inflammation scores between the Chlamydia-positive and Chlamydia-negative groups, evidenced by a sensitivity of 83% and a positive predictive value of 65% when using inflammation on Papanicolaou smears as a marker for Chlamydia infection. Grading of inflammation in the Papanicolaou smear can be of potential use in defining patients at highest risk for Chlamydia in a group considered to be at high risk based on sexual history.
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Affiliation(s)
- R J Paler
- Departments of Pathology and Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Kelly L, Bleistein A, Stevens-Simon C. Should gynecologic maturity change the management of cervical cytologic atypia during adolescence? J Pediatr Adolesc Gynecol 1999; 12:203-7. [PMID: 10584224 DOI: 10.1016/s1083-3188(99)00024-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To test the hypothesis that atypical cytology (ASCUS) portends ominous histologic diagnoses during adolescence. METHODS The prevalence of squamous intraepithelial lesions (SILs) was determined in a racially diverse group of thirty-six 14- to 21-year-olds who were undergoing colposcopic evaluation of ASCUS cytology. The prevalence of 10 widely accepted risk factors for SIL was also qualified. RESULTS SILs were detected in biopsies obtained from 20 (56%) of the 36 study subjects. There were 15 (39%) low-grade SILs and 5 (17%) high-grade SILs. No single risk factor or combination of risk factors distinguished subjects with SIL histology from those with more benign diagnoses. CONCLUSION The hypothesis was supported. More than half (56%) of the adolescents we studied with ASCUS cytology had SIL histology. The findings suggest that immediate colposcopic evaluation may be prudent for adolescents with ASCUS cytology that cannot be attributed to concurrent lower genital tract infections.
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Affiliation(s)
- L Kelly
- Department of Pediatrics, University of Colorado Health Science Center, Denver, USA
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Singh V, Parashari A, Satyanarayana L, Sodhani P, Gupta MM, Sehgal A. Biological behavior and etiology of inflammatory cervical smears. Diagn Cytopathol 1999; 20:199-202. [PMID: 10204101 DOI: 10.1002/(sici)1097-0339(199904)20:4<199::aid-dc3>3.0.co;2-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Two hundred and fifty-seven consecutive women attending a major maternal and child health (MCH) center were studied clinically, colposcopically, cytologically, and microbiologically for different gynecologic infections. Out of 257 cases, 207 (80.5%) had inflammatory cervical smears, of which 183 (88.4%) were infected with one or more genital tract infections. Bacterial vaginosis (risk, 22.6-fold), chlamydia (risk, 21.6-fold), and human papillomavirus (HPV) (risk, 13.5-fold) were independently associated with inflammatory smears. In addition, significantly higher proportions of women with inflammatory smears had cervical ectopies (28.5% vs. 10.2%) and bleeding ectopies (30.9% vs. 4.1%) as compared to noninflammatory smears. Women infected with bacterial/parasitic genital infections were given specific treatment. These women were followed up at regular intervals to assess the efficacy of antimicrobial therapy. During follow-up examination, only 26 women (12.6%) showed negative smears. Sixteen women developed squamous intraepithelial lesions (SIL) during follow-up, and 163 women had persistent inflammatory smears. Multivariate analysis revealed that persistent inflammatory smears were associated with herpes simplex virus (HSV) infection, as revealed through detection of IgA antibodies to HSV (risk, 11.5-fold). Progression of SIL was associated with HPV infection (risk, 17.6 fold). Thus, inflammatory smears are associated with different types of infection, most of which do not respond to antimicrobial therapy.
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Affiliation(s)
- V Singh
- Institute of Cytology & Preventive Oncology, Marg, New Delhi, India
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Stratton P, Gupta P, Riester K, Fox H, Zorrilla C, Tuomala R, Eriksen N, Vajaranant M, Minkoff H, Fowler MG. Cervical dysplasia on cervicovaginal Papanicolaou smear among HIV-1-infected pregnant and nonpregnant women. Women and Infants Transmission Study. JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES AND HUMAN RETROVIROLOGY : OFFICIAL PUBLICATION OF THE INTERNATIONAL RETROVIROLOGY ASSOCIATION 1999; 20:300-7. [PMID: 10077181 DOI: 10.1097/00042560-199903010-00014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the association of squamous intraepithelial lesions (SIL) on cervicovaginal Papanicolaou (Pap) smear among women infected with HIV-1 and their pregnancy status, and historical and clinical factors. METHODS Study enrollment Pap smears of 452 pregnant and 126 nonpregnant HIV-infected women had cytologic evaluation. The rates of SIL were compared with pregnancy status, immunosuppression, presence of sexually transmitted diseases (STDs) and demographic features. RESULTS Rates of low grade SIL were similar for pregnant and nonpregnant HIV-1-infected women (17% and 23.8%, respectively; p = .09). Of them, 12 women, 9 pregnant and 3 nonpregnant, had high grade SIL. None had invasive cervical cancer. Low CD4 percentage (odds ratio, [OR] = 3.8; 95% confidence interval [CI], 2.0-7.3) and inflammation (OR = 2.8; 95% CI, 1.8-4.3) were associated with SIL. An association between herpes simplex and SIL (OR = 3.3; 95% CI, 1.1-9.5) was less certain due to clinical diagnosis and low prevalence of herpes simplex (17 of 456 women). CONCLUSIONS Pap smears for a cohort of HIV-infected pregnant and nonpregnant women revealed a high prevalence of LGSIL but a low prevalence of HGSIL and no cases of cervical cancer. Although pregnancy may not affect the rate of Pap smear abnormalities, SIL is associated with immunosuppression, cervical inflammation, and herpes simplex. Closer surveillance of HIV-1-infected women with these risk factors may be warranted.
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Affiliation(s)
- P Stratton
- National Institute of Child Health and Human Development, Bethesda, Maryland 20982-1862, USA.
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Eckert LO, Watts DH, Koutsky LA, Hawes SE, Stevens CE, Kuypers J, Kiviat NB. A matched prospective study of human immunodeficiency virus serostatus, human papillomavirus DNA, and cervical lesions detected by cytology and colposcopy. Infect Dis Obstet Gynecol 1999; 7:158-64. [PMID: 10371475 PMCID: PMC1784734 DOI: 10.1002/(sici)1098-0997(1999)7:3<158::aid-idog8>3.0.co;2-v] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To compare the prevalence and type of human papillomavirus (HPV) infections in the genital tract of human-immunodeficiency-virus- (HIV) seropositive and -seronegative women matched for cytology and to examine prospectively the relationship of HPV DNA, colposcopic findings and cervical squamous intraepithelial lesions (SIL) in these matched seropositive and seronegative cohorts. METHODS A matched prospective study of HIV-seropositive and -seronegative women undergoing cytologic screening, colposcopy, and testing for HPV DNA and other infections at each visit. RESULTS Twenty-three HIV-seropositive women were matched with 23 seronegative women by cervical cytology reading, lifetime number of sexual partners, age, and follow-up length. Fourteen pairs of these women had follow-up visits every 4 months, for 56 and 53 total visits in seropositive and seronegative women, respectively. After matching, the groups had a similar overall prevalence of HPV DNA and of HPV oncogenic (high risk) types at baseline. On follow up, HIV-seropositive women were more likely than seronegative women to develop SIL (38% vs. 10%), less likely to have negative cytology (34% vs. 60%, overall P = 0.03), more visits with HPV DNA detected (68% vs. 40% P = 0.04), and more visits with multiple HPV DNA types detected (18% vs. 0%, P = 0.02). Colposcopic lesions in the seropositive women were more likely to have sharp borders or mosaicism or to be thick white (P = 0.009). CONCLUSIONS After matching for baseline Papanicolaou smear readings, these data suggest that over time seropositive women have more visits that yield abnormal cytology, more persistent HPV DNA detection, and more colposcopic abnormalities than seronegative women.
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Affiliation(s)
- L O Eckert
- Department of Obstetrics and Gynecology, University of Washington, Seattle, USA.
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Shlay JC, McGill WL, Masloboeva HA, Douglas JM. Pap smear screening in an urban STD clinic. Yield of screening and predictors of abnormalities. Sex Transm Dis 1998; 25:468-75. [PMID: 9800258 DOI: 10.1097/00007435-199810000-00005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pap smear screening studies in STD clinics have reported high rates of squamous intraepithelial lesions (SIL); however, there are limited data on levels of unsatisfactory smears of characteristics associated with cytologic abnormalities. GOAL To assess the yield to Pap smear screening in an STD clinic and to evaluate the rates of and risk factors for atypia, low-grade SIL (LSIL), and high-grade SIL (HSIL). STUDY DESIGN A chart review of the clinic records of women undergoing Pap smear screening between 1991 and 1994 was conducted. Results were assessed from two different screening protocols, the first using a Dacron swab to obtain the endocervical sample and the second using a cytobrush. RESULTS Of 2034 Pap smears, 1313 (64.6%) were negative, 202 (9.9%) were unsatisfactory, 257 (12.6%) were atypical, 211 (10.4%) had LSIL, and 51 (2.5%) had HSIL. With the change to the cytobrush protocol, the rate of unsatisfactory smears decreased from 14.4% to 3% (p < 0.001), atypia increased from 10% to 16.7% (p < 0.001), and HSIL rose from 1.7% to 3.7% (p < 0.001). By multivariate analysis, atypia was associated with genital warts (odds ratio (OR) 1.53, 95% confidence interval (CI): 1.16-2.02); LSIL with younger age (p < 0.001, for trend), black race (OR 1.51, 95% CI: 1.08-2.10), genital warts (OR 1.81, 95% CI: 1.33-2.47), and an abnormal appearance of the cervix on examination (OR 2.49, 95% CI: 1.85-3.35); and HSIL with a previous abnormal Pap smear (OR 2.48, 95% CI: 1.08-2.10). Overall, abnormality rates were significantly higher in adolescents (35.5%) than older women (21.7%) (p < 0.01). CONCLUSIONS Obtaining satisfactory Pap smears among women undergoing screening in an STD clinic is feasible and cytologic abnormalities are common. These results continue to support the need for Pap smear screening in STD clinics, but the high rates in adolescents, a group in whom the natural history of cytologic abnormalities has not been well-defined, raise questions about the need to develop age-appropriate screening and management strategies.
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Affiliation(s)
- J C Shlay
- Department of Public Health, Denver Disease Control Service, Denver Health Medical Center, Colorado, USA
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17
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Abstract
OBJECTIVE To test the value of diagnosing and treating cervical lesions at the first colposcopic visit using large loop excision of the transformation zone (LLETZ) based on abnormal colposcopic findings as compared with punch biopsies followed by subsequent therapy accordingly. PATIENTS AND METHODS Among 1255 patients with a clinically suspicious cervix, 119 patients with abnormal and satisfactory colposcopy were divided into two groups. In group A (53 patients) multiple cervical punch biopsies were taken. In group B (66 patients), LLETZ under local paracervical anesthesia was done. RESULTS Cervical intraepithelial neoplasia was diagnosed in 25 and 29 cases, condyloma acuminatum in seven and six cases, granulomatous cervicitis including tuberculous and bilharzial cervicitis was diagnosed in two and four cases in groups A and B, respectively. Endocervical adenocarcinoma was diagnosed in two cases in group B whereas microinvasive squamous cell carcinoma was diagnosed in one case in each group. Histopathologic assessment of the specimens obtained in group B revealed minimal coagulation artifact, adequate biopsies and free margins in all but three cases (4.5%) who needed further treatment by hysterectomy. In group B, only one case was complicated by a second hemorrhage and the overtreatment rate was 30.3%. On follow-up visits 20 patients (38%) and 59 patients (89%) were satisfied with the procedure in both groups, respectively. Further treatment was required in 29 cases in group A (55%) after initial assessment of punch biopsies and in three cases in group B (4.5%). Persistent abnormal colposcopic findings at follow-up visits 3 months after diathermy coagulation were seen in five patients (9.4%) in group A. CONCLUSIONS LLETZ at the first colposcopic visit is a practical and fast method of treating most cervical lesions with limited complications and has the advantage of eliminating a second session of treatment. These advantages, particularly in developing countries, may outweigh the high overtreatment rate of this procedure. Many cervical lesions can be properly treated using large loop excision of the transformation zone at the first colposcopic visit. This may help save time and resources, especially in developing countries.
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Affiliation(s)
- A Darwish
- Department of Obstetrics and Gynecology, Assiut University Hospital, Egypt
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Schwebke JR, Zajackowski ME. Effect of concurrent lower genital tract infections on cervical cancer screening. Genitourin Med 1997; 73:383-6. [PMID: 9534749 PMCID: PMC1195897 DOI: 10.1136/sti.73.5.383] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Although women attending STD clinics are at high risk for cervical cancer, most STD programmes do not include Papanicolaou (Pap) smears in their routine screening procedures. Concerns regarding reliability of this test in a population with a high rate of active infection are often raised. The objective of this study was to analyse the associations between STD diagnosis/clinical syndromes and unsatisfactory and abnormal Pap smears. METHODS Retrospective analysis of Pap results and medical records from women attending an inner city STD programme. RESULTS Of the 1202 patients analysed, 3.2% had squamous intraepithelial lesions (SIL) and 3.5% had smears which were unsatisfactory because of the thickness of the specimen. There were no associations between STD diagnoses and SIL; however, the presence of cervical inflammation was significantly associated with SIL. Pap smears which were unsatisfactory because they were too thick were also associated with the clinical finding of cervical inflammation. CONCLUSIONS The presence of active infection did not preclude the detection of SIL on Pap smears. The percentage of unsatisfactory smears resulting from inflammation was low.
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