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Unlabelled: Cervical-vaginal infection is one of the most common problems in clinical medicine .We aimed to determine the prevalence of cervical-vaginal infections in pap-smear samples from women in urban and rural areas., Method: It was a cross - sectional study which had done on 1448 non-pregnant women those had attended 12 health centers in the Dashte- Azadegan city during 2007-2011, Iran. After explained the aim of study, all subjects had signed informed consent, questionnaires regarding demographic and reproductive characteristics, and contraceptive methods used were completed by researcher. Also, pap-smear samples were prepared by a trained obstetrician and sent it to the pathology laboratory. All data were analyzed using SPSS (version 19). Descriptive and analytical statistics (chi - square test) were also applied., Results: The result showed that 55.9% and 44.1% of subjects were respectively in urban and rural areas. The mean age of women was 28±8.075. Pap smear results had shown that 8.8% of samples were infected with one of microorganisms such as Chlamydia, Candida, Cardnerella, and Trichomonas. A significant association was seen between contraceptive methods, education levels and place of residence with cervical-vaginal infections., Conclusion: The most prevalent pathogens by descending order were: Candida, Trichomonas and Gardenerella. The prevalence of cervical-vaginal infections was consistent with the results of many studies but it was different with the results of some studies. This could be due to the special conditions of social, economic and cultural of each area.

Objective: The aim of this study was to determine the role of Papanicolaou (pap) smears in the diagnosis of lower genital tract infections., Materials and Methods: A retrospective study was planned by reviewing charts of patients for trichomonas vaginalis, bacterial vaginosis, actinomyces, candida and nonspecific vaginitis., Results: Charts of 9,080 patients were reviewed and 1,733 women had a diagnosis of lower genital tract infection in the pap smear or had had a clinically treated lower genital tract infection. Only 33.5%, 30.4%, 43.3%, and 0% of patients with bacterial vaginosis, trichomonas vaginalis, candida and actinomyces, respectively on pap smear were diagnosed and treated clinically. Postmenopausal patients had a higher rate of trichomonas vaginalis infection and a lower rate of candida infection when compared to women of the reproductive age group. Patients using an intrauterine device for contraception had a statistically significantly increased rate of trichomonas vaginalis and candida infection when compared to women using other contraceptive methods or those who were not using any contraception., Conclusions: Finding trichomonas vaginalis, bacterial vaginosis and actinomyces infections in pap smears might be considered an indication for treatment without performing other diagnostic tests. Treatment of asymptomatic infections can prevent complications in selected patients. Candida can be a commensal bacteria in the vagina, therefore asymptomatic patients may not require treatment. Detection of a higher rate of trichomonas vaginalis and candida infection in IUD users shows that IUDs can increase the risk of vaginal infections and associated complications.

Although The Bethesda System 2001 attempted to standardize the criteria for specimen adequacy, much confusion still exists, which includes the significance of unsatisfactory smears, the causes and clinical conditions related to unsatisfactory smears, and the appropriate management of unsatisfactory smears. The aim of this study is to find out the clinical factors associated with unsatisfactory cervical smears. We reviewed the medical charts of patients who received conventional Pap smears between March 2006 and August 2006 in a tertiary care center. After excluding 378 cases with incomplete demographic data, the clinical data of 7,059 cases were processed for analysis. Clinical parameters retrieved included: history of pelvic malignancy, pelvic irradiation, conization, hysterectomy, pregnancy status, within 3-months postpartum. Vaginal bleeding, abnormal vaginal discharge, intrauterine device, and cervical polyps found during pelvic examinations were also documented. The 1,397 cases with history of pelvic irradiation, pelvic malignancy, and hysterectomy were excluded. Finally, 5,662 cases were enrolled for data analysis. The relationship between clinical parameters and unsatisfactory smears were analyzed by Pearson's chi-square test with Yates' continuity correction and multivariate binary logistic regression test. The incidence of unsatisfactory smears was 4.5% (252/5,662). Clinical parameters correlated with unsatisfactory smears were postpartum status (OR = 1.92, 95% CI = 1.23-3.01, P = 0.004), vaginal bleeding (OR = 2.02, 95% CI = 1.30-3.16, P = 0.002), and endocervical polyps (OR = 2.62, 95% CI = 1.39-4.947, P = 0.003). In conclusion, if any of these parameters are noted prior to obtaining a Pap smear, optimal collecting devices, better sampling techniques, and liquid-based cytology should be considered to decrease the incidence of unsatisfactory smears., (Copyright © 2009 Wiley-Liss, Inc.)

Objective: Study the reproducibility of wet smear interpretation of clue cells, lactobacillary grades and leukocyte dominance with conventional bright light and phase contrast microscopy., Study Design: Sets of vaginal specimens were taken from unselected consecutive women attending an outpatient gynaecology clinic. Air-dried vaginal fluid on a microscope slide was rehydrated with isotonic saline before examination by six independent international investigators. Some investigators initially used a conventional bright light microscope, followed by phase contrast technique., Results: Using phase contrast microscopy, an excellent inter-observer agreement was obtained among all investigators for clue cells detection (Kappa values from 0.69 to 0.94) and lactobacillary grades (Kappa 0.73-0.93). When conventional light microscopes were used, poor agreement was obtained for these criteria (Kappa index 0.37-0.72 and 0.80, respectively), but switching to phase contrast microscopy by the same investigators, improved Kappa to 0.83-0.85 and 0.88, respectively. The inter-observer agreement for estimation of the leukocyte/epithelial cell ratio (Kappa index 0.17-0.67) was poor, irrespective of the type of microscopy applied. Intra-observer agreement of clue cell detection and lactobacillary grading was also found to be excellent if phase contrast microscopy was used (Kappa 0.87-0.93), and poor with conventional bright light microscopy (Kappa 0.45-0.66)., Conclusion: Clue cells and the lactobacillary grades are reliably identified by phase contrast microscopy in wet smears, with excellent intra- and inter-observer reproducibility agreement, and better than when simple bright light microscopy was used. Evaluation of leukocyte grading, on the other hand, was inconsistent among the different microscopists, irrespective of the type of microscope used. We propose to grade the leukocytes in a different way than searching for leukocyte dominance over epithelial cells, namely by counting them per high power field and per epithelial cell.

Background: Screening for sexually transmitted infections (STIs) in the emergency department (ED) is limited by the need for pelvic examination. It has been suggested that using self-administered vaginal swabs (SAVS) for this purpose may save time and resources and may be more comfortable for patients., Objectives: The objective was to test the feasibility of using SAVS for STI screening in the ED., Methods: This was a prospective study of female ED patients 18 to 55 years old who consented to physician-assisted cervical swab (PACS) and SAVS in two urban teaching hospitals. The ED personnel offered the test to all patients, whether or not a pelvic examination was indicated, based on their chief complaint. All specimens were analyzed by polymerase chain reaction (PCR) assay. Data are presented as mean +/- standard deviation (SD). Categorical data are presented as percentages with 95% confidence intervals (CIs). Patients with a positive test result for Chlamydia trachomatis and/or Neisseria gonorrhoeae were considered positive for STI. PACS were used as the criterion standard., Results: One-hundred sixty-two subjects were enrolled from July 2006 to July 2007 (mean [+/-SD] age = 32 [+/-10] years). Eighty-one percent of patients had a genitourinary symptom (most common: vaginal bleeding/spotting). SAVS had a sensitivity of 91% (95% CI = 60% to 99%), specificity of 99% (95% CI = 95% to 99%), positive likelihood ratio of 91, and negative likelihood ratio of 0.09 in diagnosing STIs. None of the patients reported difficulty or discomfort using this technique., Conclusions: Self-administered vaginal swabs can be utilized as a feasible alternative to PACS for STI screening in the ED.

The Pap smear has been in use for more than half a century as the primary screening test for preinvasive and invasive lesions of the uterine cervix. Although not the primary use and an imperfect test, it can be extremely useful in the diagnosis of some microorganisms. This review focuses on the use of the Pap smear in the diagnosis of several microorganisms including Actinomyces, Chlamydia trachomatis, Candida, Trichomonas vaginalis, Leptothrix vaginalis, Herpes Simplex Virus, the causative agents of bacterial vaginosis, and other rarer organisms. The accuracy of diagnosis using the smear varies among the different organisms in question.

Context: Field validation of slides used in gynecologic cytology proficiency testing has surfaced as an important issue. Although the precision of diagnoses in peer-reviewed educational programs has been examined, the robustness of the validation criteria for specific types of interpretations used in proficiency testing has not been previously studied., Objective: To evaluate the robustness of validation criteria for slides entering an educational slide program., Design: We reviewed the results of the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology and compared the robustness of validation criteria for different reference diagnoses, using a total of 16,948 circulating slides., Results: Validation criteria could be divided into 2 significantly different groups. The criteria for herpes, Trichomonas, squamous cell carcinoma, and adenocarcinoma were significantly more robust than the diagnoses of unsatisfactory; negative for intraepithelial lesion and malignancy, not otherwise specified; low-grade squamous intraepithelial lesion; and high-grade squamous intraepithelial lesion (P < .001)., Conclusions: The validation criteria used in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology show 2 different levels of robustness or redundancy. These results have implications for the design of fair proficiency tests. Proficiency testing can be designed with the necessary number of reviews needed for slide validation.

Objective: To compare the Affirm VPIII Microbial Identification Test for detection and identification of Candida species, Gardnerella vaginalis and Trichomonas vaginalis to clinical and microscopic criteria commonly used to diagnose vaginitis., Methods: Women that were symptomatic for vaginitis/vaginosis and asymptomatic women being seen for routine obstetric or gynecological care were included in this study. Women treated with antibiotics or antifungals within one week or women who had douched within 24 hours were excluded. Two vaginal swab specimens were simultaneously obtained from each patient, one swab was placed in sterile physiological saline for immediate microscopic wet mount examination and KOH testing. The other swab was placed in the Affirm collection tube for Affirm VPIII testing based on previously demonstrated methods., Results: The Affirm assay was significantly more likely to identify Gardnerella and Candida than wet mount. 190 (45%) were positive for Gardnerella by Affirm compared to 58 (14%) by wet mount; 45 (11%) were positive for Candida by Affirm compared to 31 (7%) by wet mount; and 30 (7%) were positive for Trichomonas by Affirm compared to 23 (5%) by wet mount. Symptomatic women were significantly more likely to be positive by Affirm only (23% vs. 10%), wet mount only (3% vs. 2%) or Affirm and wet mount (15% vs. 1%). Asymptomatic women were significantly more likely to be negative for Affirm and wet mount (43% vs. 5%)., Conclusions: The Affirm VPIII test is a more sensitive diagnostic test for detection and identification of symptomatic vaginitis/vaginosis than conventional clinical examination and wet mount testing.

Objective: To screen cervical smears for early detection of precancerous and cancerous lesions of the uterine cervix in a hospital-based cancer screening program., Study Design: Cervical smears were collected from women attending the gynecology outdoors of various Delhi hospitals. The smears were wet fixed, processed for Papanicolaou staining and screened cytologically., Results: A total of 130,000 satisfactory smears were screened. Benign cellular changes were found in 48%. Of these, 6.9% had evidence of specific infections, while the remainder showed nonspecific, reactive changes due to inflammation/repair. In two cases, unusual, large, crescentic, septate structures were identified. These were labelled macroconidia of Fusarium species on the basis of their unique microscopic morphology. The diagnosis was confirmed on fungal culture in one case. The patient responded well to antifungal therapy., Conclusion: Cytology is a useful tool for identification of unusual fungi with characteristic microscopic morphology. A prompt cytodiagnosis in these cases can assist clinicians with management.

Objective: The Bethesda System introduced 2 categories of atypia: atypical glandular cells of undetermined significance (AGUS) and atypical squamous cells of undetermined significance (ASCUS). Our objective was to test the hypothesis that there is lack of consensus regarding management of women with ASCUS and AGUS., Study Design: A 2-page survey was mailed in April 1998 to a random sample of 491 fellows of the American College of Obstetricians and Gynecologists., Results: There were 241 responses (50.6%). For first-time ASCUS, 23.0% of respondents would perform colposcopy and 24.4% would repeat the Papanicolaou test in <3 months, indicating aggressive management of ASCUS by 47.4% of respondents. For recurrent ASCUS, 88.7% followed recommendations to manage with colposcopy. For AGUS, 23% repeated the Papanicolaou test and only 43% would manage appropriately. For recurrent AGUS, only 25% would perform surgical excision., Conclusion: Compared with published guidelines, practitioners undermanage patients with AGUS and overmanage patients with ASCUS. Further physician education appears to be warranted.

This study was conducted to compare the diagnoses and specimen adequacy of the ThinPrep (Cytyc Corporation, Boxborough, MA, USA) and conventional Papanicolaou preparation methods for cervical cytology. Cervical specimens from 972 patients from our gynecology clinic were analyzed. A single sample of the uterine cervix taken from each patient was first used to prepare the conventional Papanicolaou smear. Afterward, the residual tissue on the sampling device was rinsed into a fluid preservative from which two slides were prepared by means of the ThinPrep method. Conventional and ThinPrep slides were examined independently. Cytologic diagnoses and specimen adequacy were classified according to the Bethesda System. The diagnoses based on the ThinPrep and conventional smears matched in 939 (96.6%) cases. Low-grade squamous epithelial or higher grade lesions were detected with at least one of the methods in 59 cases and with both methods in 42 cases. Fifteen more cases of low-grade squamous epithelial or higher grade lesions (58 vs 43; p < 0.001) and 10 more cases of high-grade squamous epithelial lesions or carcinoma (42 vs 32; p = 0.006), were detected with ThinPrep than with conventional smears. The ThinPrep method yielded a higher rate of specimens that were satisfactory for cytologic examination than the conventional smears (89.8% vs 70.9%, p < 0.001). The detection rate of infectious agents was also higher with the ThinPrep method (14.9% vs 6.6%; p < 0.001). The reproducibility rate of the twin slides prepared with the ThinPrep method was greater than 99%. In conclusion, the ThinPrep method yielded a significantly higher positive detection rate of cervical abnormalities and more satisfactory specimens than conventional Papanicolaou smears.

Vaginal discomfort and/or odor are a common complaint in primary care visits by female patients. This is especially true among sexually active women of childbearing age. Because treatment varies depending upon which syndrome is present, effective treatment depends upon accurate diagnosis. The microscopic exams for diagnosing vaginal complaints are most frequently done in primary care sites. Because of this, few clinical laboratory scientists (CLSs) have the opportunity to become familiar with microscopy on this specimen type. In addition, literature on the subject is only gradually becoming available. This paper will attempt to briefly review the clinical and microscopic features of the common syndromes associated with vaginal discomfort.

Objective: False-negative reports of cervicovaginal (CV) smears (FNs) due to interpretive errors pose a significant and persistent problem in cytology. Using routinely prepared CV smears, the AutoPap 300 QC System, an automated cytology screening device, can provide an enriched population of slides for manual rescreening. In this clinical trial, the performance of the AutoPap System was assessed and compared to current random quality control (QC) selection techniques., Study Design: A total of 3,487 "within normal limits" cases were rescreened, both manually and by the AutoPap 300 QC System. Detected FNs were classified by three different methods: cytotechnologist rescreen, internal discrepancy panel and external discrepancy panel. The sensitivity of the AutoPap System to these FNs was established at five QC score thresholds., Results: By cytotechnologist rescreening, 106 FNs were identified. Subsequent internal and external discrepancy panel reviews confirmed the FNs in 80 cases and 86 cases, respectively. At a 10% review rate, the AutoPap System identified approximately 50% of the squamous intraepithelial lesion FNs., Conclusion: The AutoPap 300 QC System is a sensitive automated cytology system that has the potential of yielding five times as many FNs as a 10% random rescreen.

A complaint of vaginal discharge is one of the commonest reasons a woman consults a doctor. Accurate diagnosis of the cause is essential for satisfactory treatment. With experience, the common causes of abnormal discharge--Gardnerella vaginitis, Candida albicans and Trichomonads--can easily and rapidly be determined by examining a wet film preparation of the discharge under a simple microscope.

Results of Pap smear examinations in 1989 for disease detection in the female reproductive tract were compiled at Siriraj Hospital. The major technique was VCE. A total of 34,884 Pap smears were taken from females ranging in age from one day to 90 years; the mean age was 36.7 +/- 11.5 years. The percentage of the cytological diagnoses were: 51.6 normal smears, 45.3 infection and inflammation, 0.4 few abnormal cells, 1.1 dysplasia, 0.4 carcinoma in situ, 1.0 invasive carcinoma (0.1 keratinizing squamous cell carcinoma of the cervix, 0.4 large cell nonkeratinizing, 0.1 small cell nonkeratinizing and 0.1 adenocarcinoma; 0.1 adenocarcinoma of the corpus; and 0.2 adenocarcinoma of the ovary) and 0.2 unsatisfactory smears. Of the total number of women who underwent Pap smear examination only 5.0 per cent did so more than once a year. Hence, there should be appropriate treatment and/or sufficient investigation in women with infection and with abnormal smears.

In 37 of 43 patients (86%) with cervical stenosis (inability to undergo passage of the cotton-tipped applicator), the Cytobrush cervical sampler was successfully passed into the endocervical canal. The use of the Cytobrush sampler for cervical cytologic screening appears to be valuable in patients with cervical stenosis.

From November 1984 to January 1986, 138 women were seen in our cervical clinic with atypical squamous cells in a referring cervical Papanicolaou smear. We obtained a second smear and performed a careful pelvic examination, microscopic examination of the vaginal secretions and endocervical culture for the gonococcus. The time interval between the smear showing atypical squamous cells and the one performed in our clinic ranged from 1 to 12 months. The Papanicolaou smear from 59 (50%) of the 117 women who had it repeated within four months returned abnormal as compared to 5 (24%) of the 21 repeated after four months (P = .04). Of 41 women with persistent atypical squamous cells, 10 (24%) had a clinically detectable vaginal infection, while only 3 (4%) of the 74 women with a normal repeat smear had an infection (P less than .01). These findings suggest an association between cervical cytology showing atypical squamous cells and vaginal infections. Nevertheless, this cytologic diagnosis should not be dismissed lightly since a high percentage of women with atypical squamous cells on cytology are found to have dysplasia on colposcopically directed biopsies. The most appropriate method of evaluating these patients has yet to be determined. If the clinician elects to follow these patients with serial Papanicolaou smears, the ideal interval between smears needs to be defined. Our data suggest that an interval of four to six months would be the most efficient.

The diagnosis of Gardnerella vaginalis infection on the basis of microscopic and cultural findings was compared. A total of 340 specimens of vaginal secretion were Gram stained and plated on a medium selective for Gardnerella vaginalis. Positive culture was obtained in 165 cases. Microscopy was unequivocally positive in 95, doubtful in 58 and negative in 187. Positive microscopy was confirmed by culture in 99%. On the other hand, 21% of the negative microscopy results gave a false negative diagnosis. Specimens for which microscopy was doubtful were culture positive in 53% of the cases, including 12% with heavy growth. Thus, positive microscopy proved to be sufficient for a reliable diagnosis of Gardnerella vaginalis infection. However, in specimens with negative or doubtful microscopic findings, additional culture is recommended.

By means of thin layer chromatography amino acids, lipids and phospholipids were detected in the vaginal fluids of pregnant and nonpregnant women with and without vaginal yeast colonization. Though pregnancy and/or yeast colonization do not seem to alter qualitatively the spectrum of amino acids and lipids of the vaginal fluid, an influence is supposed of these substances - like that of glucose - on growth and metabolism of the yeasts and on the clinical manifestation of vaginal candidosis.

Between January 1971 and December 1984, a total of 57,664 Papanicolaou-stained smears from 10,968 women attending the welfare clinics of the Institute for Research in Reproduction were screened for cancer, dysplasia and other abnormalities. Among these, ova of Enterobius vermicularis were observed in six cases and an ovum of Ascaris lumbricoides was present in one case. Microfilariae were noted in three cases. Either a clean background or an inflammatory pattern was noted in the smears in these cases. These findings show that cytology is useful in the diagnosis of cervical parasitic infections in asymptomatic women.

The Bethesda System for reporting cervical/vaginal diagnoses, introduced in this article, is a flexible guideline and can be modified as appropriate to meet the needs of cytopathologists, referring physicians, and patients.