Cervical Cell Abnormalities Research Articles

Interferon-γ-induced GBP1 is an inhibitor of human papillomavirus 18

BackgroundHuman papillomavirus (HPV) infection is an important factor leading to cervical cell abnormalities. 90% of cervical cancers are closely associated with persistent infection of high-risk HPV, with the highest correlation with HPV16 and 18. Currently available vaccines and antivirals have limited effectiveness and coverage. Guanylate binding protein 1 (GBP1) was induced by interferon gamma and involved in many important cellular processes such as clearance of various microbial pathogens. However, whether GBP1 can inhibit human papillomavirus infection is unclear.ResultsIn this study, we found that GBP1 can effectively degrade HPV18 E6, possibly through its GTPase activity or other pathways, and E6 protein degrades GBP1 through the ubiquitin-proteasome pathway to achieve immune escape.ConclusionTherefore, GBP1 is an effector of IFN-γ anti-HPV activity. Our findings provided new insights into the treatment of HPV 18 infections.

CerviXpert: A multi-structural convolutional neural network for predicting cervix type and cervical cell abnormalities.

Cervical cancer, a leading cause of cancer-related deaths among women globally, has a significantly higher survival rate when diagnosed early. Traditional diagnostic methods like Pap smears and cervical biopsies rely heavily on the skills of cytologists, making the process prone to errors. This study aims to develop CerviXpert, a multi-structural convolutional neural network designed to classify cervix types and detect cervical cell abnormalities efficiently. We introduced CerviXpert, a computationally efficient convolutional neural network model that classifies cervical cancer using images from the publicly available SiPaKMeD dataset. Our approach emphasizes simplicity, using a limited number of convolutional layers followed by max-pooling and dense layers, trained from scratch. We compared CerviXpert's performance against other state-of-the-art convolutional neural network models, including ResNet50, VGG16, MobileNetV2, and InceptionV3, evaluating them on accuracy, computational efficiency, and robustness using five-fold cross-validation. CerviXpert achieved an accuracy of 98.04% in classifying cervical cell abnormalities into three classes (normal, abnormal, and benign) and 98.60% for five-class cervix type classification, outperforming MobileNetV2 and InceptionV3 in both accuracy and computational demands. It demonstrated comparable results to ResNet50 and VGG16, with significantly reduced computational complexity and resource usage. CerviXpert offers a promising solution for efficient cervical cancer screening and diagnosis, striking a balance between accuracy and computational feasibility. Its streamlined architecture makes it suitable for deployment in resource-constrained environments, potentially improving early detection and management of cervical cancer.

Improving the Accuracy and Efficiency of Abnormal Cervical Squamous Cell Detection With Cytologist-in-the-Loop Artificial Intelligence

Population-based cervical cytology screening techniques are demanding and laborious and have relatively poor diagnostic accuracy. In this study, we present a cytologist-in-the-loop artificial intelligence (CITL-AI) system to improve the accuracy and efficiency of abnormal cervical squamous cell detection in cervical cancer screening. The artificial intelligence (AI) system was developed using 8000 digitalized whole slide images, including 5713 negative and 2287 positive cases. External validation was performed using an independent, multicenter, real-world data set of 3514 women, who were screened for cervical cancer between 2021 and 2022. Each slide was assessed using the AI system, which generated risk scores. These scores were then used to optimize the triaging of true negative cases. The remaining slides were interpreted by cytologists who had varying degrees of experience and were categorized as either junior or senior specialists. Stand-alone AI had a sensitivity of 89.4% and a specificity of 66.4%. These data points were used to establish the lowest AI-based risk score (ie, 0.35) to optimize the triage configuration. A total of 1319 slides were triaged without missing any abnormal squamous cases. This also reduced the cytology workload by 37.5%. Reader analysis found CITL-AI had superior sensitivity and specificity compared with junior cytologists (81.6% vs 53.1% and 78.9% vs 66.2%, respectively; both with P < .001). For senior cytologists, CITL-AI specificity increased slightly from 89.9% to 91.5% (P = .029); however, sensitivity did not significantly increase (P = .450). Therefore, CITL-AI could reduce cytologists’ workload by more than one-third while simultaneously improving diagnostic accuracy, especially compared with less experienced cytologists. This approach could improve the accuracy and efficiency of abnormal cervical squamous cell detection in cervical cancer screening programs worldwide.

Genotype heterogeneity of high-risk human papillomavirus infection in Ethiopia.

Cervical cancer is a vaccine-preventable sexually transmitted disease. In the year 2020, there were an estimated 604,000 new cases and 342,000 deaths worldwide. Although its incidence is global, it is much higher in sub-Saharan African countries. In Ethiopia, there is a scarcity of data about the prevalence of high-risk HPV infection and its association with cytological profiles. Therefore, this study was conducted to fill this information gap. A hospital-based cross-sectional study was conducted from April 26 to August 28, 2021, and enrolled 901 sexually active women. Socio-demographic and other relevant bio-behavioral and clinical data were collected using a standardized questionnaire. Visual inspection with acetic acid [VIA] was done as an initial screening method for cervical cancer. The cervical swab was then collected using L-Shaped FLOQSwabs in eNAT nucleic acid preservation and transportation medium. A Pap test was done to determine the cytological profile. Nucleic acid was extracted using STARMag 96 ProPrep Kit on SEEPREP32. A Real-time multiplex assay was performed to amplify and detect the HPV L1 gene used for genotyping. The data were entered into Epi data version 3.1 software and exported to STATA version 14 for analysis. A total of 901 (age range from 30 to 60 years, mean age = 34.8 years, and SD± 5.8) women were screened for cervical cancer using VIA and 832 women had a valid co-testing (Pap test and HPV DNA testing) results for further process. The overall prevalence of hr HPV infection was 13.1%. Out of 832 women, 88% of them had normal and 12% had abnormal Pap test results. The proportion of high risk HPV was significantly higher among women with abnormal cytology (X 2 = 688.446, p < 0.001) and younger age (X 2 = 15.3408, p = 0.018). Among 110 women with hr HPV, 14 genotypes (HPV-16, -18, -31, -33, -35, -39, -45, -51, -52, -56, -58, -59, -66, and -68) were identified while HPV-16, -31, -52, -58, and -35 genotypes were highly prevalent. The high risk HPV infection continues to be a significant public health problem among women 30-35 years old. The presence of high-risk HPV irrespective of genotypes is highly correlated with cervical cell abnormalities. Genotype heterogeneity is observed suggesting the importance of periodic geospatial genotyping surveillance for vaccine effectiveness.

Abnormal Cervical Cell Detection Algorithm Based on Improved RetinaNet

Abnormal Cervical Cell Detection Algorithm Based on Improved RetinaNet

Prevalence of Cytological Abnormalities in Papanicolaou Smears and Risk Factors for Cervical Cancer Among Women in Muscat, Oman.

ObjectivesThis study aimed to estimate the prevalence of cytological abnormalities in Papanicolaou (Pap) smears and related risk factors among Omani women.MethodsA cross-sectional study was conducted from March to September 2019 at the gynaecology and family medicine clinics of Khoula Hospital and Sultan Qaboos University Hospital in Muscat. All asymptomatic Omani women aged between 21 and 65 years were included. Data regarding the participants’ sociodemographic characteristics and known risk factors were collected using a self-reported sheet. Pap smears were performed and the results were reported by a cytotechnologist and histopathologist.ResultsA total of 442 women participated in the study (response rate: 100%). The mean age was 39.0 ± 9.7 years old. The prevalence of cervical cytological abnormalities was 3.7%. There was a significant association between human papillomavirus (HPV) infection and cervical cell abnormalities ( P = 0.017); however, there was no link with hormonal contraception use, pregnancy before the age of 17 years or parity (P >0.050 each).ConclusionThe prevalence of cervical cell abnormalities in Oman was similar to that observed in Arab countries and relatively low in comparison to findings from Western countries. A screening program should be implemented at the primary care level. The findings of this study also highlighted the need for a future vaccination program against HPV infections.

A novel attention-guided convolutional network for the detection of abnormal cervical cells in cervical cancer screening.

Early detection of abnormal cervical cells in cervical cancer screening increases the chances of timely treatment. But manual detection requires experienced pathologists and is time-consuming and error prone. Previously, some methods have been proposed for automated abnormal cervical cell detection, whose performance yet remained debatable. Here, we develop an attention feature pyramid network (AttFPN) for automatic abnormal cervical cell detection in cervical cytology images to assist pathologists to make a more accurate diagnosis. Our proposed method consists of two main components. First, an attention module mimicking the way pathologists reading a cervical cytology image. It learns what features to emphasize or suppress by refining extracted features effectively. Second, a multi-scale region-based feature fusion network guided by clinical knowledge to fuse the refined features for detecting abnormal cervical cells at different scales. The region proposals in the multi-scale network are designed according to the clinical knowledge about size and shape distribution of real abnormal cervical cells. Our method, trained and validated with 7030 annotated cervical cytology images, performs better than the state of art deep learning-based methods. The overall sensitivity, specificity, accuracy, and AUC of an independent testing dataset with 3970 cervical cytology images is 95.83%, 94.81%, 95.08% and 0.991, respectively, which is comparable to that of an experienced pathologist with 10 years of experience. Besides, we further validated our method on an external dataset with 110 cases and 35,013 images from a different organization, the case-level sensitivity, specificity, accuracy, and AUC is 91.30%, 90.62%, 90.91% and 0.934, respectively. Average diagnostic time of our method is 0.04s per image, which is much quicker than the average time of pathologists (14.83s per image). Thus, our AttFPN is effective and efficient in cervical cancer screening, and improvement of clinical workflows for the benefit of potential patients. Our code is available at https://github.com/cl2227619761/TCT_Detection.

Cell pattern abnormalities in cervical pap smear in correlation with age and demography at a Tertiary care centre.

Introduction: Carcinoma Cervix is common all around the globe and ranked third amidst allmalignancies among women. The cervical mucosa undergoes morphologic variation with age andpractising cytopathologists is aware of these difference to make an accurate diagnosis. This studyaimed to detect abnormal cervical epithelial cell patterns in a rural population and compare lesionsor abnormal cell patterns among different age groups. Materials and Methods: This is a cross-sectional, descriptive study conducted in a tertiary care centre at the Department of Pathology over6 months. 408 women were included in the study. Data were entered in Microsoft Excel andanalyzed in SPSS software. Results: Out of 408 women included in the study, the most commonage group of the presentation was 31 to 40 years (36%), followed by 20 to 30 years (24%). NILM-Inflammatory was the most common finding (50%), followed by NILM (36%). The most commonsymptoms of presentation were Menstrual abnormalities (21%), White discharge and pruritus(18%). Findings in younger women were most commonly NILM-Inflammatory &amp; NILM whereas in thepost-menopausal age group, ASCUS, LSIL &amp; HSIL. Conclusion: All women above 30 years of ageshould undergo routine cervical cancer screening, and should continue screening even in theperimenopausal and postmenopausal age. Most women who visited the gynaecology OPD were notaware of cervical cancer screening. Hence the general population has to be educated about thebenefits of pap smear test through medical camps and awareness programs.

Examination of Pap Smear as A Screening Lesion of Cervical in Muaro Pijoan Village Working Area of Puskesmas Sungai Duren, Muaro Jambi District, Jambi Provence

Cervical cancer is a primary savage tumor that comes from squamous epithelial cells. It is the second killer after mammary cancer for women in developing countries including Indonesia. The incidence of cervical cancer in Indonesia increases that causes woman death in their productive age. Pap smear is one of method of cancer screening which is efficacious, simple, and cost effective. By applying pap smear in developing countries, the incidence of invasive cervical cancer has been reduced around 46-76% and the mortality has been declined around 50-60%. This study aims to describe clinic ocytopathology of pap smear in Muaro jambi village, Muaro Jambi district, Jambi province. This is prospective descriptive observation study at Pathology Anatomic Department of Medical Faculty, Jambi University. The data was obtained from all women that have been examined for pap smear in the public health Sungai Duren, Muaro Jambi district in July 2018. The range distribution of patients was found in 22.00-62.00 years old, multiparty woman (75.0%) with cervical chronic non specific (37,0%) and Negative for Intraepithelial Lesion (NILM) (34,0%), 20 woman with Atypical Squamous Cell of Undetermined Significance (ASCUS), 1 woman with Low Grade Squamous Intraepithelial Lesion (LSIL) and 1 woman with High Grade Squamous Intraepithelial Lesion (HSIL) as moderate dysplasia. The highest distribution abnormality of squamous epithelial cell was 41 years old, multipara (100%). Moderate dysplasia (HSIL) was woman with hormonal contraception. The incidence abnormal epithelial cervical cell was highest on 46 years old woman, with hormonal contraception and multiparty. The description of abnormal epithelial cervix cells was found to be ASCUS.

Prevalence and Factors Associated with Abnormal Cervical Cell among the Hmong and Mien Hill Tribe Women in Pha Yao Province, Thailand

Objective: To estimate the prevalence and to determine factor associated with abnormal cervical cell among the Hmong and Mien hill tribe women. Methods: A cross-sectional study aimed to estimate the prevalence and to determine the factors associated with abnormal cervical cell among the Hmong and Mien hill tribe women living in Pha Yao province, Thailand was conducted. The data from validated questionnaires and Papanicolaou (Pap) smear test results were collected. Logistic regression was used to detect the associations between variables and abnormal cervical cell at the significant level of alpha = 0.05. Results: Totally, 450 Hmong and Mien women were recruited into the analysis. The overall prevalence of abnormal cervical cell was 2.2%; 1.2% were atypical squamous cells of undetermined significance (ASC-US), 0.4% were atypical squamous cells-cannot exclude HSIL (ASC-H), 0.4% were cervical intraepithelium neoplasia-I (CIN-I) and 0.2% were cervical intraepithelium neoplasia-II (CIN-II). Two variables, the number of their sexual partners and the number of husbands’ sexual partners, were significantly associated with abnormal cervical cell. The women who had ≥ 4 sexual partners had a 7.09 times (95%CI=1.85-27.17) more likely to have abnormal cervical cell than those who had < 4 sexual partners. The women whose husbands had ≥ 4 partners had a 5.63 times (95%CI=1.51-20.90) more likely to have abnormal cervical cell than those whose husbands had < 4 sexual partners. Conclusion: The number of sexual partners is significantly associated with abnormal cervical cell among the Hmong and Mien hill tribe women. Health interventions regarding safe sex should be promoted in the hill tribe people.

Abnormal Cervical Cell Nuclei Identification Using Spatial-Context-Saliency Regions and Two-Level Cascade Classifiers

Abnormal Cervical Cell Nuclei Identification Using Spatial-Context-Saliency Regions and Two-Level Cascade Classifiers

Physical status of human papillomavirus in the prognosis of recurrence of low-grade and-high-grade cervical intraepithelial lesions

The study included 168 patients with precancerous cervical lesions 37 with low-grade squamous intraepithelial lesions (LSIL), 131 with high-grade squamous intraepithelial lesions (HSIL), and 150 women, who had not abnormal cervical cell changes. All patients underwent full colposcopy assessment, cytological/histological examination, molecular detection and genotyping of high-risk human papillomavirus. Viral load and physical status of HPV-16 DNA was evaluated in cases of mono-infection (n=208). The prevalence of virus-positive cases among the patients with LSIL/NSIL and healthy women was 78.5 and 50.7 %, respectively. The frequency of recurrence in patients with LSIL and HSIL was found to be determined by the physical status of HPV-16. A significant difference in episomal, mixed and integrated forms of HPV-16 between patients with LSIL/HSIL and patients without abnormal cervical cell changes was found (p=0.0002).

Infections of Chlamydia trachomatis and Mycoplasma hominis as Risk Factors for Abnormal Cervical Cells

Background: Cervical cancer is the fourth most common cancer among women across the world. Recent studies have shown that cervical cancer is not only caused by persistent infection of human papillomavirus (HPV), but sexually transmitted infections (STIs) also play a role in the pathogenesis of abnormal cervical cells. STIs frequently occur with no specific symptoms, such as the infections caused by Chlamydia trachomatis and Mycoplasma hominis. Asymptomatic STIs could lead to persistent infection. Persistent infections caused by STIs have been hypothesised to increase the access of HPV into the deeper cervical tissue and cause cervical cell abnormalities. Therefore, we conducted this study to assess the association between C. trachomatis and M. hominis infections and abnormal cervical cells. Methods: A cross-sectional study was performed on 58 outpatients at the Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Abnormal cervical cells were detected by a liquid-based cytology Pap smear, and bacterial identification was done by conducting conventional duplex polymerase chain reaction (PCR). Results: 58 patients, 14 (24.1%) showed abnormal cervical cells, whereas 44 (75.9%) patients showed normal cervical cells. The conventional duplex PCR demonstrated a positive result for C. trachomatis and M. hominis bacterial infections in only 1 (7.1%) and 2 (14.3%) patients with abnormal cervical cells, respectively. The statistical analysis revealed no significant association between the bacterial infections and the abnormal cervical cytology in the patients (p > 0.05). Conclusions: Infections caused by C. trachomatis and/or M. hominis were not associated with abnormal cervical cells.

Prevalence, risk factors, and pregnancy outcomes of cervical cell abnormalities in the puerperium in a hyperendemic HIV setting.

To investigate the impact of cervical cell abnormalities detected in the puerperium in association with HIV-1 infection on pregnancy outcomes. The present study was a secondary data analysis of pregnancy outcomes, Pap smear results, HIV results, and participant demography from a behavioral intervention randomized controlled trial of 1480 pregnant women aged 18years or more conducted at a periurban primary health clinic in South Africa during 2008-2010. The Pap smear was performed 14weeks after delivery. In total, 564 (38.1%) women were HIV-1-positive and 78 (8.0%) of 973 women with a categorized Pap smear result tested positive for cervical cell abnormalities; 42 (4.2%) women had low-grade squamous intraepithelial lesions (LGSILs) and 7 (0.7%) had high-grade lesions (HGSILs). In an adjusted analysis, HIV infection was significantly more common among women with LGSILs (28/42 [66.7%]) or HGSILs (6/7 [85.7%]) when compared with the other Pap smear categories (P<0.001). The rates of premature birth, low birth weight, and non-live births were similar among HIV-infected and -uninfected women with abnormal cervical cytology. Pregnant women with HIV were more likely to be diagnosed with higher grades of squamous cell abnormalities than those without HIV. There was no association between squamous cell abnormalities/HIV comorbidity and adverse pregnancy outcomes.

Imaging cervical cytology with scanning near-field optical microscopy (SNOM) coupled with an IR-FEL

Cervical cancer remains a major cause of morbidity and mortality among women, especially in the developing world. Increased synthesis of proteins, lipids and nucleic acids is a pre-condition for the rapid proliferation of cancer cells. We show that scanning near-field optical microscopy, in combination with an infrared free electron laser (SNOM-IR-FEL), is able to distinguish between normal and squamous low-grade and high-grade dyskaryosis, and between normal and mixed squamous/glandular pre-invasive and adenocarcinoma cervical lesions, at designated wavelengths associated with DNA, Amide I/II and lipids. These findings evidence the promise of the SNOM-IR-FEL technique in obtaining chemical information relevant to the detection of cervical cell abnormalities and cancer diagnosis at spatial resolutions below the diffraction limit (≥0.2 μm). We compare these results with analyses following attenuated total reflection Fourier-transform infrared (ATR-FTIR) spectroscopy; although this latter approach has been demonstrated to detect underlying cervical atypia missed by conventional cytology, it is limited by a spatial resolution of ~3 μm to 30 μm due to the optical diffraction limit.

Abstract A19: Acceptability of the Pap test versus an HPV self-sampler for cervical cancer screening among women of Haitian descent

Abstract Purpose: Cervical cancer screening disparities have been acknowledged in cities with growing Haitian populations. These disparities are attributed to high incidence and low cervical screening rates. There are barriers leading to increased disease incidence and hindering cervical cancer screenings. The purpose of this research is to replicate an evidence-based cervical cancer screening intervention Pap tes Lakay (Haitian Creole for at home Pap test). Implementing this intervention may serve as an effective strategy to help eliminate cervical cancer screening barriers in at-risk communities, including women of Haitian descent in Metro-Atlanta. Pursuit of this research endeavor will also assess cervical cancer screening preference (Self-Sampling for Human papillomavirus versus Papanicolaou test) among program participants. Methods: Pap tes Lakay is a culturally-effective approach to the cervical cancer screening disparity among Haitian women. Through this community-based participatory research (CBPR) intervention, Kobetz et al. disseminated linguistically- and culturally-appropriate cervical cancer prevention education to Haitian women utilizing community health workers (CHWs). CHWs demonstrated proper use of an HPV Self-Sampler, a device that detects abnormal cervical cell growth and other abnormalities. Investigators will replicate this evidence-based cervical cancer screening intervention and recruit and train bilingual Haitian American CHWs. CHWs will solicit participant informed consent, administer baseline surveys, deliver education, demonstrate proper Self-Sampler use, and administer post surveys. Results: A University of Miami study demonstrated high acceptability of an at-home HPV Self-Sampler. Implementation of Pap tes Lakay proved efficacious in increasing cervical cancer screening among Haitian women in South Florida. Previous results indicate 98% would recommend the HPV Self-Sampler to friends and family; 96% felt comfortable using it and 95% thought that it was easy to use. Discussion: The high rates of acceptance indicate that self-sampling may be a viable alternative to increasing cervical cancer prevention among this underserved population. This demonstrates Pap tes Lakay is a culturally-appropriate method to address cervical cancer screening disparities among women of Haitian heritage. Future plans include implementation of this evidence-based intervention in Metro Atlanta and assessing cervical screening preference among women of Haitian descent. Citation Format: Francesca Damus, Selina A. Smith, Ernest Alema-Mensah, Erin N. Kobetz. Acceptability of the Pap test versus an HPV self-sampler for cervical cancer screening among women of Haitian descent. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A19. doi:10.1158/1538-7755.DISP13-A19

Compliance with cervical cancer screening and human papillomavirus testing guidelines among insured young women

In December 2009, the American Congress of Obstetricians and Gynecologists (ACOG) recommended that women under 21 years old should not receive cervical cancer screening (Papanicolaou tests) or human papillomavirus (HPV) tests. This study examined whether clinicians stopped administering Papanicolaou and HPV tests among women younger than 21 years of age after new ACOG guidelines were issued. This study was a retrospective secondary data analysis of administrative claims data that included insurance enrollees from across the United States that examined the frequency of Papanicolaou tests and HPV tests among 178,898 nonimmunocompromised females 12-20 years old who had a paid claim for a well-woman visit in 2008, 2009, or 2010. Young women with well-woman examinations in each observed year were examined longitudinally to determine whether past diagnoses of cervical cell abnormalities accounted for Papanicolaou testing in 2010. The proportion of women younger than 21 years old that received a Papanicolaou test as part of her well-woman exam dropped from 77% in 2008 and 2009 to 57% by December of 2010, whereas HPV testing remained stable across time. A diagnosis of cervical cell abnormalities in 2009 was associated with Papanicolaou testing in 2010. However, a previous Papanicolaou test was more strongly associated with a Papanicolaou test in 2010. These data show that some physicians are adjusting their practices among young women according to ACOG guidelines, but Papanicolaou and HPV testing among insured women younger than 21 years of age still remains unnecessarily high.

Infecciones vaginales y lesiones celulares cervicales(I). Programa de cribado de otras infecciones y ETS simultáneas

Objective To evaluate a screening program for simultaneous detection of sexually-transmitted diseases and other infections in women with vaginal infections and cervical cell abnormalities diagnosed by cervicovaginal cytology. Material and methods There were 399 women with vaginal infections due to the following: Candida (95 cases), bacterial vaginosis (234 cases), Gardnerella vaginalis (14 cases), Candida plus bacterial vaginosis (9 cases), Trichomonas vaginalis (9 cases), bacterial vaginosis plus Trichomonas (1 case), human papillomavirus (HPV) (16 cases), and a history of HPV infection (21 cases). Thirty-two women had cervical cell abnormalities: atypical squamous cells of undetermined significance (ASCUS) (7 cases), atypical glandular cells of undetermined significance (AGUS) (1 case), low-grade squamous intraepithelial lesion (LSIL) (22 cases) and high-grade squamous intraepithelial lesion (HSIL) (2 cases). Analysis included erythrocyte sedimentation rate (ESR), C reactive protein (CRP), leukocyte count and lymphocyte count; HBsAg serology, hepatitis C virus (HCV) antibodies, HIV antibodies, herpes simplex virus (HSV)-2 antibodies, rapid plasma reagin (RPR), and DNA-HPV probe (Digene HPV) for high-risk (HR) and low-risk (LR) HPV. Results A total of 131 women (30.39%) were foreigners. The most frequent infections were bacterial vaginosis, with 234 cases (58.64%), and Candida infections with 95 cases (23.80%). HPV, a history of HPV and cervical abnormalities affected the younger women; among this group, there were fewer pregnancies and deliveries and a greater number of nulligravidas. Bacterial vaginosis and Candida infections affected the older women. Candida plus bacterial vaginosis showed lower CRP concentrations, and higher leukocyte count, indicating a greater response to mixed infection. With Trichomonas, lymphocyte levels were low, indicating immunodepression. The data on HPV types were as follows: the highest values were found in HPV (HR in 68.75% and LR in 62.5%), and in those with antecedents of HPV [HR in 52.38% and LR in 23.80%]. In LSIL, 72.72% were HR and 31.81% were LR. The two cases of HSIL were HR. Serology detected 33 cases of HSV-2 (7.65%), 3 cases of HBsAg (0.69%), 4 cases of HCV (0.92%), and 1 case of HIV and syphilis each (0.23%). Conclusions Screening for STD and other infections is recommended in the general population, especially in groups at high risk and showing a high prevalence of these infections, such as younger persons, in whom we identified previously undetected HPV. We recommend vaccination in cases with negative results on DNA-HPV probe, independently of age. Serology also identified known, as well as previously unknown, infections with HIV, syphilis, and hepatitis B and C viruses, demonstrating the value of screening, and allowing these infections to be treated and followed-up. In summary, we recommended screening programs for STD and other infections in women with a diagnosis of vaginal infection or cervical abnormalities in Papanicolaou cytology.

Comparison of Pap smear, visual inspection with acetic acid, and digital cervicography as cervical screening strategies

To compare the sensitivity, specificity, positive and negative predictive values (PPV and NPV), and accuracy of Pap smear, visual inspection with acetic acid (VIA) and digital cervicography (DC). This is a cross-sectional study on 100 women in the age group of 20-60 years, sequentially using the Pap test, the VIA, and the DC for screening. All women underwent colposcopic biopsy as the gold standard in comparing the methods. Of the total of 100 women with the mean age 36.0 years, 17 cases were recognized positive for abnormal cervical cell by gold standard. The sensitivity, specificity, PPV, NPV, and accuracy of the Pap test, the VIA, and the DC were 23.5, 100, 100, 86.5, and 87%; 62.5, 98.8, 90.9, 93.2, and 92.9%; and 46.7, 97.6, 77.8, 91, and 89.8%, respectively, for cervical neoplasia. The Pap test had low sensitivity but high specificity, whereas VIA had a high sensitivity in addition to being easy and low-cost. Adjuvant methods of screening such as VIA can be a valuable alternative to the Pap test for cervical cancer screening in low-resource settings.

Prevalence of abnormal cervical cytology among subfertile Saudi women

BACKGROUND AND OBJECTIVES:Since cervical cancer is reportedly the seventh most frequent cancer in women in Saudi Arabia and the eighth most frequent cancer among women aged between 15 and 44 years, we wanted to determine the prevalence of abnormal cervical cytology among subfertile women attending the reproductive medicine unit of a tertiary care center in Saudi Arabia.METHODS:This was a retrospective, cross-sectional, hospital-based study. A Pap smear was done for 241 of 493 (48.9%) subfertile women from January 2008 through February 2009.RESULTS:The Pap smear was normal in 166 of 241 patients (67.9%), abnormal in 71 (29.5%), and unsatisfactory for evaluation in 4 (1.7%). According to the revised Bethesda system, epithelial cell abnormality was found in 7 (2.9%), inflammation in 55 (22.8%), and infection in 9 (3.7%) patients. Epithelial cell abnormalities were further classified as atypical squamous cells of undetermined significance (ASC-US) (n=3, 42.8%), atypical squamous cells of high grade (ASC-H) (n=1, 14.3%), low-grade squamous intraepithelial lesion (LSIL) (n=2, 28.5%), and glandular cell abnormalities (AGS) (n=1, 14.3%).CONCLUSION:The high prevalence of abnormal cervical cytology in our subfertile women accentuates the need for screening in patients eligible for in vitro fertilization. In addition, a well-organized screening program for cervical cell abnormalities at the national level should be implemented to allow identification of subfertile women at risk so that potentially life-saving measures can be undertaken early.