Acute Cervicitis Research Articles

Atypical presentation of herpes simplex virus 2 primary infection: a case report

BackgroundCervicitis, an infectious or noninfectious inflammation of the cervix, encompasses a wide range of clinical conditions, from asymptomatic infections to severe lesions, making its diagnosis difficult. Acute cervicitis may develop into pelvic inflammatory disease. In patients with cervicitis, current guidelines recommend testing for herpes simplex virus when external genital lesions are present. Here, we present the case of a patient with an atypical primary herpes simplex virus 2 infection manifesting as cervicitis without genital lesions.Case presentationA 29-year-old Caucasian woman was hospitalized for pelvic inflammatory disease. The patient complained of severe suprapubic pain, fever, and heavy vaginal discharge. The external genitalia were unremarkable, so empirical antibiotic treatment was initiated. Despite 48 hours of well-administered antibiotic therapy, her complaints persisted. Polymerase chain reaction for possible microbial causes was negative for Chlamydia trachomatis and Neisseria gonorrhoeae. There was no bacterial vaginosis. Repeat gynecological examinations with endovaginal ultrasound revealed an enlarged cervix, and pelvic magnetic resonance imaging supported a diagnosis of cervicitis. At this point, additional screening for other sexually transmitted infections and infectious disease-related etiologies of cervicitis was performed, and the polymerase chain reaction analysis of newly isolated samples was positive for herpes simplex virus 2. No antiviral treatment was initiated given the delay in diagnosing herpes simplex virus 2 infection and the slow but spontaneous abatement of symptoms.ConclusionHerpes simplex virus infection should be considered as a possible cause of cervicitis, even in the absence of typical genital lesions. Early detection of herpes simplex virus allows early treatment, helping to reduce the duration and severity of symptoms and therefore potentially reducing recurrences and improving disease control. These data and data from future cases might spur changes in the guidelines on cervicitis testing and treatment.

Pipelle Endometrial Sampling With a Full Bladder Compared With Standard Care: A Randomized Controlled Trial.

To compare insertion failure rates for Pipelle endometrial sampling with a full bladder compared with the standard process (not taking into account bladder status) without cervical manipulation. A single-masked randomized trial was conducted in a single tertiary care center from July 2021 to January 2022. Two hundred fourteen participants aged 18 years or older who were scheduled for outpatient Pipelle endometrial sampling were randomized: 107 each to having a full bladder (by oral water intake) or standard process (without delayed sampling and bladder status not taken into account). Women with known cervical stenosis, gynecologic malignancy, uterine anomalies, leiomyoma distorting the uterine cavity, acute cervicitis, urge bladder dysfunction, intense anxiety, need for anesthesia or analgesic before the procedure, positive pregnancy test, or previous failed office endometrial sampling were excluded. The primary outcome was the insertion failure rate of endometrial sampling at first attempt. Secondary outcomes were pain during procedure, satisfaction score, analgesia use, procedure duration, and need for cervical manipulation. Factoring in a baseline insertion failure rate of 30.0%, relative risk of 0.45, α of 0.05, 80.0% power, and a dropout rate of 10.0%, we needed 107 participants in each arm. The insertion failure rate was significantly lower in the full bladder group compared with standard process: 25 of 107 (23.4%) compared with 45 of 107 (42.1%) (relative risk 0.56, 95% CI, 0.37-0.84; number needed to treat to benefit 6.0, 95% CI, 3.20-15.70). Pain score (median) during the procedure (interquartile range) was 4 (3-6) compared with 5 (3-8) ( P =.004); patient satisfaction score was 8 (7-9) compared with 7 (4-8) ( P <.001); and mean±SD procedure duration was 3.0±2.4 compared with 4.7±2.9 minutes ( P <.001) for the full bladder and standard process arm, respectively. Other secondary outcomes of cervical laceration, analgesia use, and adequacy of endometrial tissue for histopathologic assessment were not significantly different between groups. Pipelle endometrial sampling with a full bladder reduces the initial insertion failure rate, procedure-related pain, and duration of sampling and increases patient satisfaction compared with the standard process. ISRCTN, ISRCTN33938192.

Pap smear in Early Detection of Cervical Precancerous Lesions in Erbil

Background and objectives: Cervical cancer remains common. This may be because Iraq has no cervical cancer screening or human papilloma virus vaccination program. The goal of the study is to figure out how well the Pap smear works as a way to find cervical precancerous lesions also identify the prevalence of cervical cancer among women and to identify the potential risk factors for cervical cancer. Methods: A prospective cross-sectional study conducted using closed end questionnaire tool for the purpose of data collection which started from 1st of October 2021 until 1st of September 2022. Convenient type of sampling was used in collecting data which include 470 women attending to cervical screening unit in Maternity Teaching Hospital, Erbil, Kurdistan Region /Iraq. The questionnaire composed of two main parts including the socio-demographic data of the patients such as age, gender, occupation, education level, religion, income status, age at the marriage, duration of marriage…etc. The result of pap smear and cone biopsy performed during colposcopy procedure to match the accuracy of pap smear. Results: The findings revealed that 36% of the women aged between 40-49 years, the majority (80%) of them were married at the age of 15-24 years, 30% of their marriage lasted from 4-14 years, and most (72.6%) of them were housewives. The result of sensitivity, accuracy, positive and negative predicted value was equal to 45.6%, 97.7%, 80%, 89.9% respectively. The kappa test was 0.52 which indicate agreement between screening and gold standard test is a diagnosis of cervical cancer is still colposcopy-guided biopsy, which is then staged on the basis of the clinical examination and the outcome of imaging procedures, most obtained results were statistically significant. Conclusion: Pap smear had a lower sensitivity, but a higher specificity in the current study. The most common complaint of the women was post-coital bleeding. Severe acute cervicitis was the most common finding for the Pap smear.

Liquid-based Cytology Profile of Street Sex Workers in Benin City, Edo State, Nigeria

Aim: To investigate street sex workers in Benin City Edo state Nigeria using liquid-based cytology method.&#x0D; Study Design: Analytical cross-sectional study.&#x0D; Place and Duration of Study: Department of Medical Laboratory Science, Histopathology Sub-Department, University of Benin, Benin City and the Histopathology Laboratory, University of Benin Teaching Hospital (UBTH)., between December 2016 and May 2017.&#x0D; Methodology: This study was conducted in the local government areas that make up the Benin metropolitan City in Edo State. A simple random sampling method was used to recruit the 113 participants, after which the questionnaire was used as the data gathering tool. The liquid-based cytology method was used for sampling following the cervix examination by a gynecological nurse. Data were analyzed using Frequency tables, and factor analysis using Minitab version 17.0 and the statistical significance was set at p &lt; 0.05.&#x0D; Results: From a total of 113 participants within the street sex workers ring in Benin City, acute cervicitis was predominant 7/113(6.2%) closely followed by the chronic 4/113(3.5%). The prevalence of SSWs living with cervicitis in Benin City 11/113(9.7%) revealed that Teenage SSWs were 5/113 (4.4%) and Migrant SSWs 11/113 (9.7%) and were affected by age and duration of sexual practices (p= 0.583; p= 0.204). The prevalence of HPV sera-positivity revealed that 3/113(2.7%) is infected and is largely distributed amongst the age group 21-30years. A hundred percent (100%) of the SSWs agreed to having heard about condoms and have been using it; while regular condom usage was revealed in the HPV sera-negative group amounting to 101/110 (92%) and 2/3(66.7%) amongst the HPV sera-positive group.&#x0D; Conclusion: In conclusion, cervicitis is the only cervical lesion observed in the street sex workers with HPV infection predominantly affecting the age group (21-30years). Also, teenage prostitution is on the increase and HPV infection amongst the street sex workers in Benin City, Nigeria.

Cervical Power Doppler Angiography with Micro Vessel Blood Flow Indices in the Auxiliary Diagnosis of Acute Cervicitis.

We have conducted cervical imaging of uterine and micro-vessel flow velocity waveforms in acute pelvic inflammatory disease (PID) by transvaginal power Doppler ultrasound (TVPDU) in order to explore the associations of sonographic parameters with simple and complex cervicitis. Thirty-eight patients with acute PID (26 with acute simple cervicitis and 12 with complex cervicitis) were enrolled for an assessment of vascular grading of cervix and micro-vessel flow velocity using TVPDU before treatment. Seven parameters, including vascular grading (VG), lowest pulsatility index (PI), resistance index (RI), peak systolic velocity (PS), end diastolic velocity (ED), time average maximum velocity (TAMV), and vascular index (VI = PS/ED), were measured and recorded. Forty-one healthy patients were assessed as the control group. Vascular grading (VG) was significantly higher in the study group than the control group (p < 0.0001). The PI, RI, and VI were significantly lower in the study group than control group (p < 0.0001). No significant associations were observed between seven sonographic parameters and acute simple or/and complex cervicitis. For acute simple cervicitis, a PI cutoff of 1.1 had a sensitivity of 85.4% and a specificity of 92.1% (area under ROC curve [AUC], 93.2%). A RI of 0.6 had a sensitivity of 85.4% and a specificity of 78.9% (AUC, 86.1%). A VI of 2.6 had a sensitivity of 85.4% and a specificity of 78.9% (AUC, 84.9%). Power Doppler angiography of micro-vessel flow velocity waveforms in the cervix could represent a practical method to assist the diagnosis of pelvic inflammatory disease presented as acute cervicitis detected on transvaginal ultrasound before medical or surgical treatment. Cervical PI may be a useful index to detect micro-vessel flow velocity waveforms in acute cervicitis and differentiate acute simple cervicitis from complex cervicitis.

VP05.20: Direct cervical imaging in pelvic inflammatory disease presented as acute cervicitis

VP05.20: Direct cervical imaging in pelvic inflammatory disease presented as acute cervicitis

Investigating Cervical Lesion and Human Papillomavirus in Apparently Healthy Religious Women in Benin City, Nigeria

Pathological abnormalities observed in cells or tissues obtained from the uterine cervix of women are collectively referred to as cervical lesions. The condition is gradually becoming a menace as it can affect different category of women. It is more worrisome as religious women particularly are not spared from the deadly scourge. This study was to investigate cervical lesion and human papillomavirus in relatively healthy religious women attending Pentecostal churches in Benin City, Nigeria. A cross-sectional investigation of the participants using structured questionnaire and the liquid-based cytology from January to July 2017 was used as the data and sample collecting tools. Majority of religious women that participated in the survey (n=429) cut across 47 Pentecostal churches. The mean age of the respondents was 48.46years (±2SD) with the highest number of participants being age group (36-45years) 131/429(31%), and ≥66years 13/429(3%). HPV infection was 9/429(2.1%), and the worst hit was among age group (26-35years) 5/429(1.2%) followed by 3/429(0.7%) amongst age group 36-45years, and 1/429 (0.2%) from age group 46-55years. 51/429(11.89%) was cervical lesion positive, while cytopathology revealed inflammatory smears (acute and chronic cervicitis), atypical glandular cells (AGC), low-grade squamous cell intraepithelial lesions (LSIL), and atypical squamous cells of undetermined significance (ASCUS). Cervical lesion and subsequent HPV infections are prevalent within the study population. However, to avert the impending dangers (cervical cancer) posed by cervical lesions in the society, modesty in sexual exploitation and decent lifestyles are highly imperative.&#x0D; Keywords: Cervical cancer, Cervical lesion, Uterine cervix, Uterine infections, Religious women.

Comparison of diagnostic accuracy of papanicoloau (PAP) Smear and visual inspection using acetic acid (VIA) in screening of cervical carcinoma, taking biopsy as gold standard.

Study Design: Cross-sectional descriptive study. Setting: Department of Obstetrics &amp; Gynecology, Bahawal Victoria Hospital, Bahawalpur. Period: 05 August 2016 to 05 Feb 2017. Material &amp; Methods: A total of 228 suspected patients of cervical carcinoma and age of 20-50 years were included. Patients with acute cervicitis, pregnant females, h/o abnormal cytology and obvious lesion on cervix were excluded. All the patients were underwent papanicoloau (PAP) smear and visual inspection using acetic acid. The results of papanicoloau (PAP) smear and visual inspection using acetic acid (VIA) were compared with cervical biopsy report. Results: In 110 papanicoloau (PAP) smear positive patients, 97 were True Positive and 13 were False Positive. Among, 118 papanicoloau (PAP) smear negative patients, 18 were False Negative whereas 100 were True Negative. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of papanicoloau ( PAP )smear in screening of cervical carcinoma was 84.35%, 88.50%, 88.18%, 84.75% and 86.40% respectively. In 114 visual inspection using acetic acid (VIA) positive patients, 95 were True Positive and 19 were False Positive. Among, 114 visual inspection using acetic acid (VIA) negative patients, 20 were False Negative whereas 94 were True Negative. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of visual inspection using acetic acid ( VIA) in screening of cervical carcinoma was 82.61%, 83.19%, 83.33% 82.46% and 82.89% respectively. Conclusion: This study concluded that papanicoloau ( PAP) smear and visual inspection using acetic acid (VIA) in screening of cervical carcinoma are highly sensitive, accurate and having almost equal diagnostic accuracy.

Comparison of the AV Magnivisualizer device with colposcopy to detect cervical intraepithelial neoplasia using the Swede scoring system

To compare the AV Magnivisualizer with colposcopy to detect cervical intraepithelial neoplasia (CIN) using the Swede scoring system. Cross-sectional study conducted in a tertiary care hospital from May 2017 to March 2018. One hundred women with positive results at visual inspection with acetic acid underwent cervical inspection using the Magnivisualizer followed by a colposcope. Biopsies were taken if the Swede score was greater than 4. Pregnant women, women with an obvious cervical growth, acute cervicitis, or prior cervical surgery were excluded. Diagnostic accuracy of the Magnivisualizer and colposcope was calculated for high-grade lesions (CIN2/CIN2+) and agreement was compared between the two modalities. The sensitivity, specificity, and positive and negative predictive values of the Magnivisualizer were 88.2%, 70.0%, 50.0%, and 94.6%, respectively, to detect high-grade lesions at a Swede score cutoff of 5 or more. The area under the curve for the Magnivisualizer was 0.80 (95% CI, 0.67-0.92), which was comparable with colposcopy (AUC 0.86; 95% CI, 0.76-0.96). There was very good agreement between the Magnivisualizer and colposcopy (κ=0.865, P<0.001) for high-grade lesions. The Magnivisualizer had high diagnostic accuracy to detect high-grade CIN in screen-positive women, which was comparable with colposcopy.

New serum biomarker identification and analysis by mass spectrometry in cervical precancerous lesion and acute cervicitis in South China.

Background: According to the statistics of WHO/IARC, cervical cancer (CC) has become the fourth malignant cancer of female worldwide and it is one of the main causes of death of women in developing countries.Purpose: Potential plasma and metabolic biomarkers for CC precancerous lesions and cervicitis were indicated by LC-MS techniques, and their underlying mechanisms and functions were analyzed.Methods: Plasma samples were selected from healthy people (control), low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), CC, and post-treatment patients. All polypeptide types and sequences were detected by LC-MS/MS and the results were normalized by using Pareto-scaling. Potential metabolic biomarkers were screened by applying MetaboAnalyst 4.0 software and XCMS software, and analysis of variance and enrichment analysis were performed. Metabolic pathway analysis and functional enrichment analysis were used to further investigate the significance and pathological mechanisms of potential biomarkers.Results: Compared with healthy people, 9 differentially expressed metabolites were screened, 4 of which were up-regulated and 5 were down-regulated. LSIL group screened 7 differentially expressed metabolites, 5 of which were up-regulated and 2 were down-regulated; CC group screened 12 differentially expressed metabolites were screened, of which 9 were up-regulated and 3 were down-regulated. Eight differentially expressed metabolites were screened in the IF group, of which 5 showed up-regulation and 3 showed down-regulation. In functional enrichment analysis, differential metabolism was found to be associated with addition and coagulation cascades. Among all potential biomarkers, 2-amino-3-methyl-1-butanol, L-carnitine, Asn Asn Gln Arg, Ala Cys Ser Trp, Soladulcidine, Ala Ile Gln Arg, 2-amino-3 -Methyl-1-butanol, L-carnitine, Asn Asn Gln Arg, Ala Cys Ser Trp, Soladulcidine, Ala Ile Gln Arg can be used as predictors of precancerous lesions at different stages of CC. Among all biomarkers, 6α-fluoro-11β1,17-dihydroxypren-4-ene-3,20-dione has higher expression in the CC and HSIL groups and lower expression in the treatment group.Conclusion: By applying molecular markers to assess the progression of the disease, the accuracy and specificity of the diagnosis can be improved, which has certain prospects in clinical applications.

Regular condom use tends to decrease cervical lesions in resident-commercial sex workers in Sub-Saharan Africa

BACKGROUNDCervical lesions are abnormalities seen in tissues and cells examined from the uterine cervix. These abnormalities are on the increase and are ignored; thereby constituting major health problems in resident commercial sex workers (CSWs) who temporarily reside in brothels for sex business. Hence, we investigated the associations between behavioural risk factors and cervical lesions in resident commercial sex workers. METHODSWe conducted a cross-sectional study among 119 resident commercial sex workers using questionnaires as the data gathering tool, liquid-based cytology for cervical lesions screening, and microscopy for examination of slides. Statistical analyses were conducted using Epi- Info™ version 6.4 and STATISTICA (StatSoft, version 5, 2009 Edition, Atlanta, GA 30329-4027 USA). Data were analysed using multivariate and simple logistic regression analyses, while the level of significance was set at p £0.05. RESULTSThe behavioural risk factors, like smoking and hard drugs, alcohol intake, commercial sex duration, client’s daily patronage and sex frequency were not significant apart, but regular condom use tends to decrease the cervical lesions in CSWs (OR=0.91;95% C.I. 0.92-1.06), including anal and oral sex (OR = 0.99 (95% C.I. 0.29-3.60). The patterns of cervical lesions further showed acute and chronic cervicitis with a prevalence of 10.1%, including low-grade squamous intraepithelial lesion (LSIL) and atypical squamous cells of undetermined significance (ASCUS). We recorded 8/12 (66.7%) for acute cervicitis, 4/12 (33.3%) chronic, and 82.4% negative. CONCLUSIONWe suggest that behavioural risk factors are associated with cervical lesions and that regular condom use tends to decrease cervical lesions among resident CSWs.

Identifying acute cervicitis in an era of less-frequent routine gynecologic examinations.

Acute inflammation of the uterine cervix can lead to serious problems such as pelvic inflammatory disease (PID), endometritis, and complications of pregnancy and childbirth. As intervals for routine gynecologic screening examinations lengthen, cervical infections, especially if asymptomatic, may be missed. Annual wellness examinations and other patient visits outside routine gynecologic cancer screening visits should include brief evaluation with sexual risk assessment and a gynecologic examination if indicated. If cervicitis persists after standard treatment for sexually transmitted infections (STIs), consider Mycoplasma genitalium. Clinicians should be sensitive to the fact that the unexpected presence of infection may cause distress.

National Institute of Allergy and Infectious Diseases workshop report: “Chlamydia vaccines: The way forward”

Chlamydia trachomatis (Ct), an intracellular pathogen, is the most common bacterial sexually transmitted infection. In addition to acute cervicitis and urethritis, Ct can lead to serious sequelae of significant public health burden including pelvic inflammatory disease (PID) and infertility. Ct control efforts have not resulted in desired outcomes such as reduced incidence and reinfection, and this highlights the need for the development of an effective Ct vaccine. To this end, NIAID organized a workshop to consider the current status of Ct vaccine research and address critical questions in Ct vaccine design and clinical testing. Topics included the goal(s) of a vaccine and the feasibility of achieving these goals, animal models of infection including mouse and nonhuman primate (NHP) models, and correlates of protection to guide vaccine design. Decades of research have provided both whole cell-based and subunit vaccine candidates for development. At least one is currently in clinical development and efforts now need to be directed toward further development of the most attractive candidates. Overall, the discussions and presentations from the workshop highlighted optimism about the current status of Ct vaccine research and detailed the remaining gaps and questions needed to move vaccines forward.

Clinical Effect of Integrated Traditional Chinese and Western Medicine in Treating Acute Cervicitis

&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; To investigate the clinical effect of integrated traditional Chinese and western medicine in treating acute cervicitis. &lt;strong&gt;Methods:&lt;/strong&gt; 81 cases of patients with acute cervicitis which were treated in our hospital from September 2013 to March 2015 were selected as research objects. According to the method of random sampling, the patients were divided to A group (Integrated traditional Chinese and western medicine treatment), B group (Western medicine treatment) and C group (TCM treatment) with 27 cases in each group.&lt;strong&gt; Results:&lt;/strong&gt; The treatment of integrated traditional Chinese and western medicine is much easier to get patients’ acceptance and affirmation. Besides that, the clinical effect of feedback is better than the single use of traditional Chinese medicine or western medicine treatment. &lt;strong&gt;Conclusion:&lt;/strong&gt; The clinical effect of integrated traditional Chinese and western medicine in the treatment of acute cervicitis is better than the use of traditional Chinese medicine or western medicine.&lt;/p&gt;

Asociación de infección por Chlamydia trachomatis con el diagnóstico de cervicitis aguda

Introducción: la infección por Chlamydia trachomatis es la enfermedad de transmisión sexual más frecuente en el mundo y causa una importante morbilidad en las mujeres. Actualmente existen pocos estudios sobre su prevalencia en nuestra población, por lo que se hace pertinente la implementación de un estudio piloto que aporte información sobre su frecuencia en mujeres asintomáticas y con cervicitis aguda. Objetivo: determinar la asociación existente entra la infección por Chlamydia trachomatis y la presencia de cervicitis aguda en la población consultante a los servicios de urgencias y consulta externa del Hospital Universitario de Santander (HUS). Metodología: estudio de casos y controles en el cual se incluyeron 284 pacientes mayores de edad, no embarazadas y que no estuvieran menstruando, atendidas en el HUS. Se tomaron como casos las pacientes con diagnóstico de cervicitis aguda y controles aquellas sin el mismo. En los dos grupos se realizó un frotis endocervical al cual se aplicó un método de diagnóstico rápido para infección por Chlamydia trachomatis, Bioline Chlamydia SD®. Resultados: el promedio de edad fue de 32.08 y 28.82 para casos y controles, con una diferencia promedio de 3.27, p = 0.001. También hubo diferencias al evaluar estado civil; 82.40% de los controles tiene un vínculo marital frente al 71.83% de los casos, p = 0.014; ocupación, más estudiantes en el grupo de cervicitis que en los casos, p = 0.020; y consumo de alcohol, 21.13% de pacientes con cervicitis, contra 11.27% de los controles, p = 0.024. La prevalencia de infección por Chlamydia en los controles fue de 7.04% y 11.97% en los casos, p = 0.157. Al buscar una asociación entre cervicitis aguda y la infección por Chlamydia esta no se encuentra, OR = 1.79 (IC 95% 0.74 – 4.55). Esta falta se asociación se mantiene luego de ajustar los potenciales factores confusores (OR = 1.71, IC 95% 0.72 – 4.04). En el análisis multivariado solo el consumo de alcohol persiste asociado con la presencia de cervicitis, OR = 4.442 (IC 95% 1.362 – 14.215). Conclusiones: no se encontró asociación entre la infección por Chlamydia trachomatis y el diagnóstico de cervicitis aguda. Se encontró una prevalencia similar en los dos grupos, además no se encontraron diferencias sociodemográficas. El único factor de riesgo con una asociación fuerte para colonización por la bacteria y cervicitis aguda fue la historia de consumo de alcohol. [Jaimes-Bravo JM. Asociación de infección por Chlamydia trachomatis con el diagnóstico de cervicitis aguda. MedUNAB 2015; 18 (2): 116-124]

Cytopathological Examination and Epidemiological Study of Cervicitis in Commercial Sex Workers (CSWs) in Coal City (Enugu), Nigeria.

llicit sexual behavior by commercial sex workers (CSW) may have a disproportionate impact on the reproductive health of a woman that often leads to cervicitis. This study aimed at examining the cytopathology, patterns, prevalence and burden of cervicitis in CSW in Enugu metropolis, Nigeria. Cervical smear was collected from the endocervix of about one hundred and eighteen (n=118) CSWs between November, 2014 and February, 2015 using the liquid-based cytology (LBC) method. Smears were processed and stained by the modified Papanicolaou method. Leftover samples were tested for sexually transmitted diseases, especially N. gonorrhea, and C. trachomatis using ligase chain reaction and nucleic acid amplification test. A randomized sampling design was used for data collection. Cytopathological examination of cervicitis in CSWs showed a moderate infection, and moderately severe to chronic inflammatory cells. The epidemiological study revealed that acute cervicitis are predominant 7(5.9%) and 2(1.7%) are chronic cervicitis. The prevalence of CSWs living with cervicitis in Enugu, Nigeria (7.6%), is significantly affected by age and working duration as CSWs. Also, Chlamydia trachomatis is the solely associated pathogen implicated in cervicitis group (n=9). Candidiasis infection (n=12) and T. vaginalis (n=3) are observed in non-cervicitis group (n=109) while the association between C. trachomatis and cervicitis infection is statistically significant (P= 0.0221). Acute cervicitis was prevalent with a preponderance of 4:1 in CSWs in Enugu, Nigeria. C. trachomatis infection was the most prevalent etiologic agent of cervicitis in this study. Further molecular study of LBC smears from CSWs using PCR is strongly recommended.

An Extreme Case of Chronic Cervicitis Mimicking Cervical Cancer and Causing Third-Degree Prolapse

Background: Cervicitis is an inflammatory response of the cervix to stimuli; this response may may be acute or chronic. Chronic cervicitis results from repeated episodes of acute cervicitis or an incomplete treatment of the latter. Most cases are asymptomatic or present with vaginal discharge, intermenstrual bleeding, dyspareunia or postcoital bleeding. Sometimes, this benign condition may present in unusual forms proving to be a diagnostic problem for clinicians. It is uncommon to find huge cervical growths caused by chronic cervicitis with uterovaginal prolapse. This article reports on a case of chronic cervicitis that presented as a cervical growth resembling cervical cancer and that produced a third-degree uterine prolapse. Case: A 55-year-old postmenopausal female presented with an irreducible genital prolapse with an intermittent, foul-smelling, blood-mixed discharge. She had this condition for 10 years. She had a 5×5–cm, irregular, fungating mass protruding out of her introitus. This mass was a cervical growth with a pinpoint os identified using a uterine sound. Thus, a clinical diagnosis of cervical cancer or genital tuberculosis with a third-degree cervical descent was made. A biopsy of the cervical growth revealed chronic cervicitis with no evidence of dysplasia. The patient's uterus was atrophic with a bulky cervix. A panhysterectomy was performed. Results: histopathology testing reconfirmed that this patient had chronic cervicitis. Her postoperative period was uneventful. Conclusions: Any cervical growth should be biopsied for histologic confirmation of cervical carcinoma, genital tuberculosis, and chronic cervicitis. The latter conditions without prolapse can be managed medically in young women, but surgical management is required for menopausal women with prolapse. (J GYNECOL SURG 30:380)

Underrecognition of cervical Neisseria gonorrhoeae and Chlamydia trachomatis infections in pregnant patients in the ED

Study ObjectivesThe purposes of this study were to (1) quantify the frequency of underrecognized Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) infections in pregnant women tested in the emergency department (ED), (2) describe the characteristics of those not treated during the initial visit, and (3) determine how many pregnant women with acute cervicitis were lost to follow-up. MethodsThis was a retrospective, cohort analysis of consecutive women seen in the ED of 3 academic medical centers during a 36-month study period, with positive results for GC/CT. Our key outcome measures were the proportion of pregnant women being untreated in the ED, the time to subsequent treatment, and the proportion lost to follow-up. ResultsDuring the study period, 735 female patients had positive polymerase chain reaction study results for GC and/or CT; 179 (24%) were pregnant. Overall, 143 of these pregnant patients with cervicitis (80%) were not treated in the ED. Presenting symptoms included abdominal pain (71%), nausea (45%), vaginal discharge (35%), vaginal bleeding (34%), and urinary complaints (22%). The most common discharge diagnoses were vaginitis (37%), urinary infection (33%), threatened abortion (19%), nonspecific abdominal pain (9%), and rule-out ectopic pregnancy (6%). Of the 143 patients with sexually transmitted infection not treated in the ED, 114 (80%) were contacted by telephone and/or mail. Twenty-nine (20%) were subsequently lost to follow-up. ConclusionsFurther study is warranted to enhance point-of-contact testing and identify better mechanismsfor contact and follow-up after ED discharge and more liberal policies to treat less symptomatic patients empirically.

Flavonoid Naringenin: A Potential Immunomodulator forChlamydia trachomatisInflammation

Chlamydia trachomatis, the agent of bacterial sexually transmitted infections, can manifest itself as either acute cervicitis, pelvic inflammatory disease, or a chronic asymptomatic infection. Inflammation induced by C. trachomatis contributes greatly to the pathogenesis of disease. Here we evaluated the anti-inflammatory capacity of naringenin, a polyphenolic compound, to modulate inflammatory mediators produced by mouse J774 macrophages infected with live C. trachomatis. Infected macrophages produced a broad spectrum of inflammatory cytokines (GM-CSF, TNF, IL-1β, IL-1α, IL-6, IL-12p70, and IL-10) and chemokines (CCL4, CCL5, CXCL1, CXCL5, and CXCL10) which were downregulated by naringenin in a dose-dependent manner. Enhanced protein and mRNA gene transcript expressions of TLR2 and TLR4 in addition to the CD86 costimulatory molecule on infected macrophages were modulated by naringenin. Pathway-specific inhibition studies disclosed that p38 mitogen-activated-protein kinase (MAPK) is involved in the production of inflammatory mediators by infected macrophages. Notably, naringenin inhibited the ability of C. trachomatis to phosphorylate p38 in macrophages, suggesting a potential mechanism of its attenuation of concomitantly produced inflammatory mediators. Our data demonstrates that naringenin is an immunomodulator of inflammation triggered by C. trachomatis, which possibly may be mediated upstream by modulation of TLR2, TLR4, and CD86 receptors on infected macrophages and downstream via the p38 MAPK pathway.

A cyto-epidemiological study on married women in reproductive age group (15-49 years) regarding reproductive tract infection in a rural community of West Bengal

Reproductive tract infection (RTI) represents a major public health problem in India. Women are either not aware of the symptoms of RTI or refuse to seek health care due to economic and time constrains unless suffering from alarming symptoms. To find out the prevalence of women with suggestive symptoms of RTI; to identify clinical and cytological abnormalities among the symptomatic women and to find out association between socio-demographic profile and risk factors with RTI symptomatic and cytology positive patients. A total of 385 married women in reproductive age group residing in Baligori sub-center area in Tarakeswar block of Hooghly district, West Bengal, India, were screened for symptom suggestive of RTI; symptomatic women went through gynecological examination and cancer cervix screening by Pap smear. Analysis of results was done by Odds ratio and multivariate logistic regression. Overall, 23.6% of the study population had symptoms suggestive of RTI. Most of them (68.1%) had abnormal vaginal discharge. Among the symptomatic women, cytology proved that 24.4% were suffering from acute cervicitis, 4.7% from A Squamous Cell of Undetermined Significance (ASCUS) and 2.3% from Low Grade Intra epithelial Lesion (LSIL) Squamous. Statistically significant association was observed for age, number of children, contact history of husband, pond bathing, menstrual hygiene, intra uterine device insertion, non-usage of barrier method, and history of abortion among women symptomatic for RTI and asymptomatic women. Prevalence of suggestive symptoms of RTI in women was found to be high (23.6%), and among them 7% had cervical dysplasia. Therefore, enhancing awareness and organizing screening camps are absolute necessity and must be held at frequent intervals to curb the menace due to cervical cancer.