Diagnosis Of Cervicitis Research Articles

Human papillomavirus genotypes and infection among women in Changzhou, China

ABSTRACT Human papillomavirus (HPV) infection is a major cause of cervical cancer. HPV vaccine has been shown to be highly effective in preventing HPV infection, and understanding the genotypes of HPV infection can guide the utilization of HPV vaccine. This epidemiological study aimed to investigate the genotype distribution of HPV in HPV-positive female patients in Changzhou. This study enrolled HPV-positive female patients admitted at the Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University were enrolled in this study. HPV genotypes were identified via standard HPV DNA testing. The cohort comprised 5738 patients, that the predominant genotypes were HPV52 (13.4%), HPV16 (9.6%), HPV58 (8.8%), HPV81 (8.6%), and HPV53 (7.7%). HPV infection prevalence was the highest among those aged 41–45 y (16.6%), followed by those aged 31–35 y (15.1%) and 36–40 y (15.1%). In total, 46.8% of infections were found in women aged 31–45 y. The main genotypes of HPV infection upon physical examination or diagnosis of cervicitis and cervical cancer were HPV52, 16, 58, 81, and 53. HPV52, 16, 58, 81, and 53 are the most predominant genotypes of HPV infection. Further, HPV infection is most prevalent among women aged 31–45 y. Our findings provide experimental evidence for guiding HPV vaccination policy.

The Additive Value of Pelvic Examinations to History in Predicting Sexually Transmitted Infections for Young Female Patients With Suspected Cervicitis or Pelvic Inflammatory Disease

We evaluate the additive value of pelvic examinations in predicting sexually transmitted infection for young female patients with suspected cervicitis or pelvic inflammatory disease in a pediatric emergency department (ED). This was a prospective observational study of female patients aged 14 to 20 years who presented to an urban academic pediatric ED with a complaint of vaginal discharge or lower abdominal pain. Enrolled patients provided a urine sample for chlamydia, gonorrhea, and trichomonas testing, which served as the criterion standard for diagnosis. A practitioner (pediatric ED attending physician, emergency medicine or pediatric resident, pediatric ED fellow, or advanced practice provider) obtained a standardized history from the patient to assess for cervicitis or pelvic inflammatory disease according to the Centers for Disease Control and Prevention criteria. They then recorded the likelihood of cervicitis or pelvic inflammatory disease on a 100-mm visual analog scale. The same practitioner then performed a pelvic examination and again recorded the likelihood of cervicitis or pelvic inflammatory disease on a visual analog scale with this additional information. Using the results of the urine sexually transmitted infection tests, the practitioner calculated and compared the test characteristics of history alone and history with pelvic examination. Two hundred eighty-eight patients were enrolled, of whom 79 had positive urine test results for chlamydia, gonorrhea, or trichomonas, with a sexually transmitted infection rate of 27.4% (95% confidence interval [CI] 22.6% to 32.8%). The sensitivity of history alone in diagnosis of cervicitis or pelvic inflammatory disease was 54.4% (95% CI 42.8% to 65.5%), whereas the specificity was 59.8% (95% CI 52.8% to 66.4%). The sensitivity of history with pelvic examination in diagnosis of cervicitis or pelvic inflammatory disease was 48.1% (95% CI 36.8% to 59.5%), whereas the specificity was 60.7% (95% CI 53.8% to 67.3%). The information from the pelvic examination changed management in 71 cases; 35 of those cases correlated with the sexually transmitted infection test and 36 did not. For young female patients with suspected cervicitis or pelvic inflammatory disease, the pelvic examination does not increase the sensitivity or specificity of diagnosis of chlamydia, gonorrhea, or trichomonas compared with taking a history alone. Because the test characteristics for the pelvic examination are not adequate, its routine performance should be reconsidered.

The Effect of Flixweed-Honey Vaginal Product on Cervicitis: a Clinical Trial

Background and objectives: Cervicitis is a common and recurrent gynecologic disease which is usually resistant to treatments. This study was conducted to investigate the effect of Iranian traditional medicine (ITM) product, flixweed- honey, on cervicitis. Methods: A quasi-experimental study was conducted as a clinical trial before and after the intervention at the School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. The married women referring to the clinic aged 17-55 years with a diagnosis of cervicitis who were not pregnant and breastfeeding, without any history of cervical polyps and pelvic surgery, and non-concurrent use of herbal or other chemical medicines were included in the study. During this research, 97 patients were treated through the vaginal use of flixweed- honey for two weeks. One week after the treatment, clinical symptoms were examined. Results: Among 97 patients who were evaluated in this study, 72 returned for follow-up. All subjective and objective parameters including vaginal irritation, itching, discharge, bleeding and pain after coitus, tenderness, and cervical wound size and friability improved significantly in comparison to the time before taking the medication. There was no treatment; five patients (0.69%) who took the medication had vulvovaginal itching that was resolved after 3-4 days. Conclusions: Vaginal product of flixweed– honey could be used in the treatment of clinical symptoms of cervicitis regardless of the reason causing cervicitis, without causing severe or serious side effects.

Faktor risiko servisitis pada wanita pekerja seks di kegiatan layanan infeksi menular seksual mobile

Purpose: This study aimed to identify risk factors of cervicitis among female sex workers in the district of Cilacap. Methods: This study used a cross-sectional design. Total of respondents were 147 female sex workers who participated in the mobile sexual transmitted infection services. Demographic characteristic and risk factor data were collected by interviews using a structured questionnaire. Diagnosis of cervicitis was obtained by laboratory test with cervix swab. Data were analyzed using Poisson regression test with robust variance estimators.Results: Prevalence of cervicitis among female sex workers in the district of Cilacap were 70.75%. Multivariate analysis showed that the risk factors of cervicitis among female sex worker were: age ≤24 years old, income, childbirth history, number of clients per week, and inconsistent of condoms use.Conclusions: Results showed the need to increase awareness of condom use among female sex workers through health promotion and counseling in mobile sexual transmitted infection services by the teams of sexual transmitted infection clinics. Potential targets for outreach health promotions and counseling are younger female sex worker (≤30 years old).

Abstract B10: Predictive and prognostic biomarkers at personalized treatment of locally advanced cervical cancer

Abstract Introduction: Cervical cancer is one of the most prevalent malignancy and of higher mortality in the world, and is considered a marker of underdevelopment. Conventional radiotherapy is one of the treatments used for this type of cancer. 30 to 40% of patients with similar prognosis factors not respond equally to a comparable standard treatment. The poor response to radiotherapy leads to the development of innovative and effective therapies for cervical cancer locally advanced, metastatic and refractory. A comparative analysis of cervical cancer in the context of other cancers may reveal that it is relatively smaller number of targeted molecular agents that have been tested. Accordingly, a number of biological agents are currently in clinical development for the purpose of, inhibiting angiogenesis, molecularly address EGFR and IGF-1R, modulation of cell cycle, of histone deacetylases, COX-2, mTOR and tumor microenvironment (hypoxia and glycolysis). Within work that we have been developing, reported that gene expression of IGF1R is a strong predictive marker for lack of response to radiotherapy, patients have 28.6 times higher risk of failure treatment; Patients & Methods: This prospective cohort study included 149 patients with squamous cell carcinomas of the uterine cervix in FIGO stages IIB and IIIB between 2008 and 2011. The mean age was 46 years. Of the 149 patients, 61 were treated with radiotherapy and 88 with concurrent radiochemotherapy. Expression of the proteins CAIX, GLUT-1, HIF1α, HKII, IGF-IRα, IGF-IRβ and Survivin was determined by immunohistochemistry and P53 Arg72Pro polymorphism by allele specific PCR in biopsies taken before treatment. Results: The highest increase was found in expression of GAPDH (100%), Survivin (87%), followed of, IGF-IRα (76.5%), IGF-IRβ (74.5%), IGF-IRα and IGF-IRβ concordance in the expression(73%), HIF1α (74.1%); strong expression was observed with low frequency for GLUT-1 (31.1%), CAIX (16.2%), HKII (10.6%). For polymorphism Arg72Pro of P53 was found that genotype Arg/Arg is the most frequently (59.8) in patients with cervical locally advanced cancer and that compared to the control group (non-tumor tissue of the cervix with histopathologic diagnosis of cervicitis without evidence of squamous intraepithelial lesion or malignancy) (P = 0.000), and published reports, his presence confirms their possible participation in the development of this cancer, however we found no association with the outcome and response to treatment. Patients who received chemoradiotherapy compared to those who received radiotherapy showed higher survival times, both for overall survival and disease-free. Patients with hemoglobin levels ≤ 11g/dl had a risk 2.53-fold (p = 0.01) decrease in both the overall survival rate as the rate of disease-free survival. Conclusions: We found that the expression of IGF-IRβ detected by immunohistochemistry is a prognostic marker that affects overall survival and disease-free survival; the detection and study before treatment of the expression of HIF1α, CAIX, GLUT 1 and HKII, considered as biological factors pre-existing, contributes to infer the metabolic and hypoxic state, as also at the rational use of new modalities in radiotherapy, radiochemotherapy and gene therapy in the regulation of hypoxia. Citation Format: Pablo Moreno-Acosta, Oscar Gamboa, Alfredo Romero-Rojas, Jinneth Acosta, Martha Cotes Mestre, Diana Mayorga, Magda Pacheco, Gladys Aguilera, Nicolas Magné. Predictive and prognostic biomarkers at personalized treatment of locally advanced cervical cancer. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2015 Nov 5-9; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(12 Suppl 2):Abstract nr B10.

Cervicitis: limited clinical utility for the detection of Mycoplasma genitalium in a cross-sectional study of women attending a New Zealand sexual health clinic

Although multiple studies have confirmed Mycoplasma genitalium as a cause of nongonococcal urethritis in men, there is less evidence of its pathogenicity in women. Our aims were to determine the prevalence of M. genitalium in a sample of women attending a sexual health clinic and to assess whether there was any association between the detection of M. genitalium and a diagnosis of cervicitis in this population. A cross-sectional study recruited women who required screening for sexually transmissible infections. Endocervical swabs to detect the presence of M. genitalium were taken in addition to routine testing for Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis. Data were collected on demographics, sexual behaviour, clinical symptoms and the presence of clinical or microscopic cervicitis. The prevalence of M. genitalium was 8.4% (n=22, 95% confidence interval (CI): 5.4-12.5%) in the study sample of 261 women. There was an association between the finding of cervical contact bleeding (odds ratio OR): 5.45; 95% CI: 1.93-15.42, P=0.001) and microscopic cervicitis (OR: 2.64; 95% CI: 0.95-7.34, P=0.06) and the presence of M. genitalium when compared with women with no diagnosed infection; however, the latter finding was not statistically significant. Although the prevalence of M. genitalium was high at 8.4%, the overall lack of any association between the findings of cervicitis and the detection of M. genitalium support the conclusion that cervicitis has poor clinical utility as an indicator for the presence of M. genitalium infection.

OP19.05: Ultrasound for discrimination between acute salpingitis and other conditions in patients with clinical signs and symptoms suggesting acute salpingits: a prospective observational cross sectional study

Objectives: To describe ultrasound findings in patients with acute salpingitis and to determine if it is possible using ultrasound to discriminate between acute salpingitis and other painful conditions mimicking clinical symptoms/ findings of acute salpingitis. Methods: 52 patients underwent a standardized transvaginal ultrasound scan before diagnostic laparoscopy because of clinical suspicion of acute salpingitis. The laparoscopist was blinded to scan results. Final diagnosis was based on laparoscopy, histology of the endometrium or other histology where relevant. Results: 29 patients had a final diagnosis of cervicitis (n = 3), endometritis (n = 9), or salpingitis (n = 17), 23 (44%) had a diagnosis unrelated to genital infection. In 4 cases the salpingitis was mild, in 8 moderate, in 5 severe (pyosalpinx). Bilateral adnexal masses and bilateral masses lying adjacent to the ovary were seen more often at scan in patients with salpingitis than with other diagnoses (14/17 vs. 6/35, P = 0.000; 11/17 vs. 6/35, P = 0.001). In salpingitis, the masses lying adjacent to the ovaries were on average 2–3 cm in diameter, solid (n = 14), unilocular (n = 4) or multilocular (n = 3) cystic, or multilocular solid (n = 1), and well vascularized at color Doppler. Spectral Doppler results overlapped between patients with different diagnoses. The sensitivity with regard to acute salpingitis of subjective assessment of scan findings by the sonologist was 82%, specificity 77%, positive and negative likelihood ratio (LR+) 3.6 and 0.23. Those of scan findings of bilateral masses lying adjacent to the ovary were 65%, 83%, LR+ 3.8 and LR− 0.42. The corresponding figures for bilateral adnexal masses were 82%, 83%, 4.8 and 0.22. Conclusions: In patients with clinical suspicion of acute salpingitis, absence of bilateral adnexal masses at scan decreases the odds of acute salpingitis 5-fold.

A Practical Approach to the Diagnosis of Pelvic Inflammatory Disease

The diagnosis of acute pelvic inflammatory disease (PID) is usually based on clinical criteria and can be challenging for even the most astute clinicians. Although diagnostic accuracy is advocated, antibiotic treatment should be instituted if there is a diagnosis of cervicitis or suspicion of acute PID. Currently, no single test or combination of diagnostic indicators have been found to reliably predict PID, and laparoscopy cannot be recommended as a first line tool for PID diagnosis. For this reason, the clinician is left with maintaining a high index of suspicion for the diagnosis as he/she evaluates the lower genital tract for inflammation and the pelvic organs for tenderness in women with genital tract symptoms and a risk for sexually transmitted infection. This approach should minimize treating women without PID with antibiotics and optimize the diagnosis in a practical and cost-effective way.

Current UK practice in the diagnosis of cervicitis: Time for a change?

Current UK practice in the diagnosis of cervicitis: Time for a change?

Partner referral as a component of integrated sexually transmitted disease services in two Rwandan towns.

To document partner referral rates at health centres with improved STD services, and to determine factors contributing to successful referral. Partner referral was initiated as part of the upgrading of STD services in primary care health facilities in two semi-urban Rwanda towns. After syndromic management of the presenting complaint, index patients received prevention education and condom demonstration, and were urged to refer sexual partners to the health centre for a free examination. Partner referral coupons linked by code number to the symptomatic index patient were given to facilitate referral; no identifying information was collected on partners from the index patients. Three quarters of the symptomatic patients seen at the two primary health care facilities were women. Overall, the ratio of referred partners to index patients was 26%. Only 58% of index patients accepted partner referral coupons. The referral rate for those who did accept coupons was 45%. Partner referral worked best for regular partners. Most index patients and partners were married and only four index patients referred more than one partner. Women index patients, especially when pregnant, were more successful in referring partners than men. Index patients who referred partners tended to be older than those who did not. Awareness of STD symptoms in the partner, and diagnosis of cervicitis were associated with a higher rate of STD symptoms in the partner, and diagnosis of cervicitis were associated with a higher rate of partner referral. Efforts to improve rates of partner referral should begin at the clinic level with improved counselling to convince more index patients of the importance of partner referral. Partner symptom recognition may be useful for increasing rates of partner referral. Supplementary strategies are needed to reach non-regular partners. When syndromic management is used, counselling should take into account the lower predictive values of identifying STD in women in order to avoid partner accusation. Despite limitations, patient referral of sexual partners can be an effective strategy for reaching a population at high risk for STD with minimal additional investment in health worker staff time.

Cervicitis as a Clinical Indicator of Gonococcal and Chlamydial Infections in Pregnancy

Objective: We undertook the present study to attempt to apply clinical indicators predictive of cervical infection in nongravid populations with either Neisseria gonorrhoeae or Chlamydia trachomatis to our pregnant population and to determine the significance of the clinical diagnosis of “cervicitis.” Methods: A retrospective chart review of all pregnant women with a final diagnosis of cervicitis who were seen in the Medical College of Virginia obstetrical emergency room was performed during the period of September 1991 to December 1992. Results: Given the diagnosis of cervicitis in our emergency department, we found that the clinical examination predicted cervical infection with N. gonorrhoeae or C. trachomatis in only 20% of the pregnant women. Gravidas with chlamydial infections were younger (20.1 ± 3.7 years) compared with gravidas not infected (23.2 ± 5.4 years) (P < 0.0001). They were also more likely to have a diagnosis of lower urinary-tract infection [relative risk (RR) 2.89, 95% confidence interval (CI) 1.42–5.85]. Conclusions: The clinical indicators of cervical infection with C. trachomatis and N. gonorrhoeae were unreliable.

Comparison between vaginal swab and endocervical swab during pelvic examination

Purpose: While wet mounts and potassium hydroxide (KOH) preparations are frequently used to help diagnose vaginitis and cervicitis, the sample site varies. This study was conducted to evaluate whether the specimen site (vaginal pool versus endocervical specimen) affects diagnostic sensitivity. Methods: The study involved 116 consecutive adolescent females presenting to a medical clinic serving highrisk youth. During the pelvic examination, specimens were obtained from the endocervix and the vagina (posterior fornix and sidewall) and placed in separate tubes of normal saline. Each specimen was examined for trichomonads, white blood cells, pseudohyphae, clue cells, and amine odor using 10% potassium hydroxide. Results: The sensitivity was highest for the vaginal specimen in detecting the presence of trichomonads (100% versus 50%), pseudohyphae (76% versus 65%), and clue cells (95% versus 50%). For those with symptomatic candida vaginitis ( n = 12), there was no difference in sensitivity (83%) between the two methods for detecting pseudohyphae. Nineteen of the adolescents had a diagnosis of cervicitis (chlamydia by DFA, gonorrhea by culture, and trichomonas by wet mount). If >5 white blood cells/high powered field (WBC/HPF) was used as a criterion for the presence of a cervicitis, the vaginal sample had a sensitivity of 79% (15/19) and a specificity of 67%, while the endocervical sample had a 74% sensitivity (14/19) and a 57% specificity. Conclusions: A wet mount obtained from either the vaginal pool or endocervix is not highly specific for diagnosing a vaginitis or cervicitis. However, obtaining a specimen for wet mount and KOH swab from the vaginal pool is more sensitive for detecting trichomonads, pseudohyphae, or clue cells than an endocervical swab.

Selective Screening for Chlamydia trachomatis Infection in Nonurban Family Planning Clinics in Wisconsin

To determine the prevalence of, and identify risk factors for, Chlamydia trachomatis infection, we studied 380 women attending four Wisconsin family planning clinics in October 1985. The patients completed self-administered sexual history questionnaires, were examined by nurse clinicians and had specimens taken for direct fluorescent antibody (DFA) testing for C. trachomatis. Of 335 women with adequate specimens, 10.7 percent had positive DFA tests. Selective screening criteria were developed based on the following risk factors for C. trachomatis: Age less than 20 years and recent exposure to either a new sexual partner or a partner with more than one partner; a partner with symptoms of urethritis; a diagnosis of cervicitis; and inflammatory changes on Pap smear. Thirty-six percent of patients met one or more of these screening criteria, and the criteria had a sensitivity of 72 percent.

Cervical conization in pregnancy: Analysis of 180 operations

An analysis of 180 cone biopsies during pregnancy was made involving 178 patients treated during a 13 year period. Indications for conization in pregnancy were essentially the same as those for the nonpregnant patient. In the first trimester, 33 conizations were done (18 per cent), 42 were done in the second trimester (23 per cent), and 105 in the third trimester (59 per cent). The diagnosis of cervicitis was given in 21 conizations (11.7 per cent), 49 gave the diagnosis of dysplasia (27.2 per cent), 96 carcinoma in situ (53.3 per cent), and 14 invasive carcinoma (7.8 per cent). No maternal deaths occurred. Of the 175 pregnancies that have terminated, 20 did not produce a fetus that survived (11.4 per cent). A total of 11 pregnancies ended with abortion (6.3 per cent), 4 with delivery of an immature infant (2.3 per cent), 24 with delivery of a premature infant (13.7 per cent), and 136 with delivery of a term infant (77.7 per cent). The corrected abortion and premature rates are consistent with our general population. We conclude that benefits of early diagnosis and treatment of cervical cancer outweigh the risks involved with conization biopsy of the cervix during pregnancy.