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Inflammatory cells in liquid-based cytology smears classified as bacterial vaginosis
José Eleutério1,2, Renata Mírian Nunes Eleutério3, Leonardo Arruda Martins2
1Department of Maternal and Child Health, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil.
Insights
The presence of leukocytes in bacterial vaginosis (BV) cases may indicate mixed infections or epithelial changes. This finding suggests BV with leukocytes (BV-L) might be linked to conditions like Candida co-infection and ectopy.
Area of Science:
- Gynecology
- Microbiology
- Cytopathology
Background:
- Bacterial vaginosis (BV) is characterized by an absence of inflammation, despite the common presence of leukocytes.
- Understanding the role of leukocytes in BV is crucial for accurate diagnosis and management.
Purpose of the Study:
- To investigate the clinical and microbiological differences between BV cases with and without significant leukocyte presence.
Main Methods:
- A transversal study analyzed 1178 BV cases diagnosed via liquid-based cytology.
- Cases were categorized into BV (few leukocytes) and BV-L (≥5 leukocytes per field).
- Statistical analysis included Fisher exact and Student t tests with a 95% confidence interval.
Main Results:
- The BV-L group showed higher frequencies of Candida sp co-occurrence (15.1% vs. 1.5%) and cellular atypia (9.6% vs. 5.7%) compared to the BV group.
- Colposcopy findings suggestive of colpitis and ectopy were more prevalent in the BV-L group.
- Age was the only differing socio-demographic variable between the groups.
Conclusions:
- Leukocyte presence in BV (BV-L) may signify mixed infections, potentially involving Candida species.
- Ectopy and epithelial atypia are more frequently observed in BV cases with leukocytes.
- The findings suggest that BV-L warrants further investigation for co-infections and associated conditions.
Background:
Bacterial vaginosis (BV) remains an enigmatic question. The term "osis" instead of "itis" is used because commonly, there are no inflammatory process associated with BV. However, leukocytes are often observed in it.
Methods:
In a transversal study, we evaluated 1178 cases with diagnosis of BV by liquid-based cytology (more than 20% of clue cells), attended in general gynecologic private clinic. Depending of the presence of more than five leukocytes on average per field in immersion objective (1000×), the cases were divided in two groups: few or no leukocytes (< 5 leukocytes per field) (BV) and with leukocytes (≥ 5 leukocytes per field) (BV-L). The Fisher exact and Student t tests was applied to a confidence interval of 95%. The project was approved by the Ethic Committee of Federal University of Ceará, Brazil.
Results:
The age between the groups was the only different socio-demographic variable. The assessment of vaginal discharge aspect had no characteristic aspect. Colposcopy findings suggesting colpitis and ectopy were more frequent in the group of BV-L, 7.1% and 6.9%, respectively. The study of the microbiology demonstrated in the BV-L group, more frequently co-occurrence of Candida sp (15.1%) than in BV group (1.5%) (P < .0001). The cellular atypia was present more frequently in the BV-L (9.6%) than in BV (5.7%) (P = .0116).
Conclusion:
The presence of leukocytes in BV (or BV-L) may suggest a mixed infection, ectopy influencing the vaginal milieu and even epithelial atypia.
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