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Inflammatory epithelial changes and nonviral cervicovaginal pathogens
L E Frisch1, L D Buckley, S A Chalem
1Student Health Service, Southern Illinois University, Carbondale.
Insights
Inflammatory epithelial changes (IECs) in cervical smears are linked to higher rates of Chlamydia infection and elevated vaginal pH. These findings suggest a need to re-evaluate current treatment guidelines for IEC.
Area of Science:
- Gynecology
- Infectious Diseases
- Cytopathology
Background:
- Cervicovaginal infections can present with inflammatory epithelial changes (IECs) on cytologic examination.
- The association between IECs and specific infections like Chlamydia requires further investigation.
- Current management of IECs often involves empirical treatment, which may not always be necessary.
Purpose of the Study:
- To determine the prevalence of specific cervicovaginal infections and elevated vaginal pH in women with cytologic diagnoses of IEC.
- To compare infection rates and pH levels between women with IECs and a control group.
- To assess the utility of current treatment guidelines for IECs.
Main Methods:
- A case-control study involving 249 women with cytologic diagnoses of IEC and 211 controls.
- Microbiological testing for Chlamydia, Monilia, and Trichomonas.
- Vaginal pH measurement.
- Comparison of infection prevalence and pH between cases and controls.
Main Results:
- Chlamydia infection was found in 15.7% of IEC cases, significantly higher than in controls (7.6%).
- Elevated vaginal pH (>5.5) was observed in 29.7% of IEC cases, compared to 10.7% in controls.
- Prevalence of Monilia and Trichomonas did not differ significantly between groups.
Conclusions:
- The study highlights a significant association between IECs and Chlamydia infection, as well as elevated vaginal pH.
- Findings challenge the routine empirical treatment of IECs, suggesting a need for targeted diagnostic approaches.
- Reevaluation of current clinical guidelines for managing IECs is warranted based on these results.
Abstract:
To assess the relationship between inflammatory epithelial changes (IECs) and cervicovaginal infection, 249 women with cytologic diagnoses of IEC were studied. The findings showed a Chlamydia infection in 15.7% of the cases, Monilia in 38.1%, Trichomonas in 1.6% and a lateral vaginal wall pH of greater than 5.5 in 29.7%. These results were compared with those for 211 controls drawn from the same population; women with abnormal cytologic reports were excluded from the control group. The controls had a prevalence of yeast and trichomoniasis no different from that of the IEC group. In contrast, the prevalence of chlamydial infection (7.6%) and pH greater than 5.5 (10.7%) were significantly lower in the controls than in the IEC cases. Chlamydia was found in 30.2% of 43 women with an atypical transformation zone, equally distributed between women whose biopsies were normal and those whose biopsies showed cervical intraepithelial neoplasia. The traditional guidelines of treating cases with cytologic diagnoses of IEC prior to obtaining a repeat smear may need reevaluation in the light of these findings.