In the 12 mth ended 30 June 1976, 14,868 cervical smears (from 13,212 patients) were examined in the Cytology Department, King George V Hospital, Sydney. Forty-two smears (1 in 354), from 37 patients, showed features of viral or chlamydial infection. Appearances were considered diagnostic in 21 smears and suggestive of infection in a further 21 smears. Changes were seen which were attributable to herpes virus, the virus of condyloma acuminatum, cytomegalovirus, adenovirus and TRIC agents. Six smears showed changes consistent with infection by virus other than those mentioned. The most characteristic feature of viral and chlamydial infection is the presence of inclusion bodies in endocervical and metaplastic squamous cells. Intranuclear inclusions are seen in herpes (where the cells are often multinucleate), cytomegalovirus and adenovirus infection. These are eosinophilic in herpes and adenovirus and basophilic in cytomegalovirus infection. Eosinophilic intracytoplasmic inclusions are seen in TRIC agent infection and sometimes in cytomegalovirus infection. Recognition is important for several reasons. Cytologically, changes due to viral and chalmydial infection may be present in association with or may also to some extent simulate precancerous or cancerous changes. Epidemiologists have considered the possibility that a sexually transmitted viral carcinogen is important in the aetiology of cervical cancer. Clinically infection may be asymptomatic or be responsible for severe, even necrotizing, cervicitis. The presence of herpes, cytomegalovirus and TRIC agents in the genital tract in early pregnancy is associated with abortion, prematurity and dysmaturity. Some obstetricians consider the presence of herpes or cytomegalovirus in late pregnancy an indication for caesarean section before membrane rupture in order to prevent serious, and sometimes fatal, infection of the neonate occurring during delivery through an infected birth canal.
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