Evaluation of gynecological complaints of women having inflammatory changes in their cervicovaginal smears

Year 2021, Volume: 46 Issue: 1, 81 - 87, 31.03.2021

Hanife Guler Donmez , M.sinan Beksac

Abstract

Purpose: Inflammatory Pap-test is reported commonly, however, there is no consensus on its clinical significance. This study was to investigate the presence of gynecological complaints such as vaginal discharge, pruritus, burning, odor, and pelvic/abdominal pain in women who are having inflammatory changes in their cervicovaginal smears.
Materials and Methods: The cervicovaginal smears of 854 women, between the ages of 18 and 76 (38.7 ± 11.18) years, were evaluated. Papanicolaou staining was used for cytological evaluation. For the diagnosis of inflammation, polymorphonuclear leucocytes (PMNLs) were counted in at least five visual fields (×100). PMNLs counts “above 40” were recorded as inflammation positive.
Results: Inflammation was detected in 115 of the 854 (13.5%) patients; these were considered the study group. Cytological specimens with various types of infections and epithelial cell abnormalities were excluded from the cohort (n = 221, 25.8%). Patients without any infection (n = 518, 60.7%) were accepted as the control group. In the study group, gynecological complaints including vaginal discharge, pruritus, burning, odor, and abdominal pain were found at rates of 56.5%, 6.1%, 3.5%, 4.3%, and 7.8%, respectively. The presence of vaginal discharge was statistically significant in women with inflammation (56.5%) compared to the control group (25.9%).
Conclusion: Vaginal discharge is significantly more frequent in women with inflammatory changes in their cervicovaginal smears.

Keywords

Inflammation, Papanicolaou staining, vaginal discharge, cervicovaginal smears

Servikovajinal smearlarında inflamatuar değişiklikler bulunan kadınların jinekolojik şikayetlerinin değerlendirilmesi

Abstract

Amaç: İnflamasyon Pap-testinde yaygın olarak rapor edilmektedir, ancak klinik önemi konusunda bir fikir birliği yoktur. Servikovajinal simirlerde inflamatuar değişiklikler olan kadınlarda vajinal akıntı, kaşıntı, yanma, koku, pelvik/karın ağrısı gibi jinekolojik şikayetlerin varlığını araştırılması amaçlanmıştır.
Gereç ve Yöntem: 18-76 (38.7 ± 11.18) yaşları arasındaki 854 kadının servikovajinal simirleri değerlendirildi. Papanicolaou boyama yöntemi sitolojik değerlendirme için kullanıldı. İnflamsyon teşhisi için, polimorfonükleer lökositler (PMNL'ler) en az beş görsel alanda (×100) sayıldı. "40'ın üzerindeki" PMNL sayıları, inflamasyon pozitif olarak kaydedildi.
Bulgular: 854 hastanın 115'inde (%13.5) inflamasyon tespit edildi; bunlar çalışma grubu olarak kabul edildi. Çeşitli enfeksiyon türleri ve epitel hücre anormallikleri olan sitolojik örnekler kohorttan çıkarıldı (n = 221, %25,8). Herhangi bir enfeksiyonu olmayan hastalar ise (n = 518, %60,7) kontrol grubu olarak kabul edildi. Çalışma grubunda vajinal akıntı, kaşıntı, yanma, koku ve karın ağrısı gibi jinekolojik şikayetler sırasıyla %56,5, %6,1, %3,5, %4,3 ve %7,8 oranında bulundu. İnflamasyonlu kadınlarda vajinal akıntı varlığı (%56.5) kontrol grubuna (%25.9) göre istatistiksel olarak anlamlıydı.
Sonuç: Vajinal akıntı, servikovajinal smearlarında inflamatuvar değişiklikler olan kadınlarda anlamlı olarak daha sıktır.

Keywords

İnflamasyon, Papanicolaou boyama yöntemi, vajinal akıntı, servikovajinal simir

References

• 1. Eckert LO, Koutsky LA, Kiviat NB, Krone MR, Stevens CE, Eschenbach DA. The inflammatory papanicolaou smear: What does it mean? Obstet Gynecol. 1995;86:360-6.
• 2. Beghini J, Giraldo PC, Eleutério J, Amaral RL do, Polpeta NC, Gonçalves AK. Vaginal inflammation: Association between leukocyte concentration and levels of immune mediators. Am J Reprod Immunol. 2016;75:126-33.
• 3. Baka S, Tsirmpa I, Chasiakou A, Tsouma I, Politi E, Gennimata V, et al. Inflammation on the cervical papanicolaou smear: evidence for infection in asymptomatic women? Infect Dis Obstet Gynecol. 2013;2013:184302.
• 4. Ayres de Campos D, Nogueira A, Magalhães F, Bayer P, Monteiro J, Lameirão A, et al. Células inflamatórias na citologia cervicovaginal. Um achado tradutor de infecção? [Inflammatory smears in cervicovaginal cytology. A finding meaning infection?]. Acta Med Port. 1997;10:637-41.
• 5. Bertolino JG, Rangel JE, Blake RL Jr, Silverstein D, Ingram E. Inflammation on the cervical papanicolaou smear: The predictive value for infection in asymptomatic women. Fam Med. 1992;24:447-52.
• 6. Anderson MR, Klink K, Cohrssen A. Evaluation of Vaginal Complaints. JAMA. 2004;291:1368-79.
• 7. von Glehn MP, Sidon LU, Machado ER. Gynecological complaints and their associated factors among women in a family health-care clinic. J Family Med Prim Care. 2017;6:88-92.
• 8. Spence D, Melville C. Vaginal discharge. BMJ. 2007;335:1147-51.
• 9. Schwebke JR. Vaginal Discharge In: Jeffrey D. Klausner, MD, Edward W. Hook III, MD, editors. Current Diagnosis and Treatment of Sexually Transmitted Diseases. New York: McGraw-Hill Medical; 2007.
• 10. Hammond R. Gynaecological causes of abdominal pain. Women's Health Medicine. 2006;3:124-7.
• 11. Prakash M, Patterson S, Kapembwa MS. Macrophages are increased in cervical epithelium of women with cervicitis. Sex Transm Infect. 2001;77:366-9.
• 12. Dönmez HG, Demirezen Ş, Beksaç MS. Detection of the Wnt/Beta-catenin signaling activity by using immunocytochemical technique in cervical smears. Gynecol Obstet Reprod Med. 2013;19(2):91-5.
• 13. Barouti E, Farzaneh F, Sene AA, Tajik Z, Jafari B. The pathogenic microorganisms in Papanicolaou vaginal smears and correlation with inflammation. J Family Reprod Health. 2013;7:23-7.
• 14. Bertolino JG, Rangel JE, Blake RL Jr, Silverstein D, Ingram E. Inflammation on the cervical Papanicolaou smear: the predictive value for infection in asymptomatic women. Fam Med. 1992;24:447-52.
• 15. Verma A, Verma S, Vashist S, Attri S, Singhal A. A study on cervical cancer screening in symptomatic women using Pap smear in a tertiary care hospital in rural area of Himachal Pradesh, India. Middle East Fertil Soc. J 2017;22:39-42.
• 16. Srinivasamurthy B, Balamurugan M, Velu AK. Clinicopathologic significance of Papanicolaou smear study of postmenopausal women in a rural tertiary care center. Clin Cancer Investig J. 2015;4:147.
• 17. Sharma D, Upreti S. Pap smear in detection of cervico-vaginal lesions in women: A clinical study. International Journal of Medical and Health Research. 2017;3:122-4.
• 18. Gami N, Trivedi S, Bhutia K, Puri M, Aggarwal K. Persistent inflammation on Pap smear: Does it warrant evaluation? Indian J Cancer. 2011;48:220.
• 19. Fernandes JV, DE Medeiros Fernandes TA, DE Azevedo JC, Cobucci RN, DE Carvalho MG, Andrade VS, et al. Link between chronic inflammation and human papillomavirus-induced carcinogenesis (Review). Oncol Lett. 2015;9:1015-26.
• 20. Capaldo CT, Nusrat A. Cytokine regulation of tight junctions. Biochim Biophys Acta. 2009;1788:864-71.
• 21. Barrios De Tomasi J, Opata MM, Mowa CN. Immunity in the Cervix: Interphase between Immune and Cervical Epithelial Cells. J Immunol Res. 2019;2019:7693183.
• 22. Förster C. Tight junctions and the modulation of barrier function in disease. Histochem Cell Biol. 2008;130:55-70.
• 23. Kobielak A, Boddupally K. Junctions and inflammation in the skin. Cell Commun Adhes. 2014;21:141-7.
• 24. Kounis NG, Soufras GD, Tsigkas G, Hahalis G. White blood cell counts, leukocyte ratios, and eosinophils as inflammatory markers in patients with coronary artery disease. Clin Appl Thromb Hemost. 2015;21:139-43.
• 25. Randjelovic I, Moghaddam A, Freiesleben de Blasio B, Moi H. The Role of Polymorphonuclear Leukocyte Counts from Urethra, Cervix, and Vaginal Wet Mount in Diagnosis of Nongonococcal Lower Genital Tract Infection. Infect Dis Obstet Gynecol. 2018;2018:8236575.
• 26. Madendag Y, Sahin E, Aydin E, Col Madendag I, Acmaz G, Karaman H. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio can be useful markers for distinguishing uterine adenomyosis and leiomyoma. Gynecol Obstet Reprod Med. 2018;24:147.
• 27. Mertoglu C, Gunay M, Gungor M, Kulhan M, Kulhan NG. A Study of inflammatory markers in gestational diabetes mellitus. Gynecol Obstet Reprod Med. 2018;25:1.
• 28. Boon ME, Suurmeijer AJH. The Pap Smear. 3rd ed. London: Harvard Academic Publishers; 1996.
• 29. Dasari P, Rajathi S, Kumar SV. Colposcopic evaluation of cervix with persistent inflammatory Pap smear: A prospective analytical study. Cytojournal. 2010;7:16.
• 30. Demirezen S, Dönmez HG, Özcan D, Beksaç MS. Evaluation of the relationship between fungal infection, neutrophil leukocytes and macrophages in cervicovaginal smears: Light microscopic examination. J Cytol. 2015;32:79-84.
• 31. Chakravarti A, Rusu D, Flamand N, Borgeat P, Poubelle PE. Reprogramming of a subpopulation of human blood neutrophils by prolonged exposure to cytokines. Lab Investig. 2009;89:1084-99.
• 32. Kurose N, Mizuguchi S, Ohkanemasa Y, Yamashita M, Nakano M, Guo X, Aikawa A, Nakada S, Sasagawa T, Yamada S. Adenosquamous carcinoma of the uterine cervix displaying tumor-associated tissue eosinophilia. SAGE Open Med Case Rep. 2019;7:2050313X19828235.
• 33. Lam KK, Simonds JL, Archer C, Ditzel AK, Wall S, Goyal V, et al. Gynecological and obstetric emergencies. In: Borhart J, Bavolek R, editors. Essential Emergency Medicine. Philadelphia: Elsevier Inc.; 2007:497-554.