Frequency of Trichomonas vaginalis, Candida sp and Gardnerella vaginalis in cervical-vaginal smears in four different decades

CONTEXT: Vaginitis is one of the principal motives that lead women to seek out an obstetrician or gynecologist. Bacterial vaginosis, candidiasis and trichomoniasis are responsible for 90 percent of the cases of infectious vaginitis. OBJECTIVE: To verify the frequency of the three main causative agents of vaginitis, Trichomonas vaginalis, Candida sp and Gardnerella vaginalis, in four different decades (1960's, 1970's, 1980's and 1990's). DESIGN: Retrospective. PLACE: A tertiary referral center. PARTICIPANTS: Patients attended to as gynecology and obstetrics outpatients at the Faculdade de Medicina do Triângulo Mineiro during the years 1968, 1978, 1988, 1998, taken as samples of each decade. MAIN MEASUREMENTS: Diagnoses of infection by Trichomonas vaginalis, Candida sp and Gardnerella vaginalis were gathered from 20,356 cervical-vaginal cytology tests on patients attended to as gynecology outpatients at Faculdade de Medicina do Triângulo Mineiro during the years 1968, 1978, 1988, 1998, representing the four decades. The results were grouped according to the age group of the patients: under 20, between 20 and 29, between 30 and 39, between 40 and 49, and 50 or over. Statistical analysis was done via the chi-squared (Mantel-Haentzel) test with a significance level of 5 percent. RESULTS: In 1968 infections by Trichomonas vaginalis and Candida sp were diagnosed in 10 percent and 0.5 percent of the cytology tests and in 1978, 5.1 percent and 17.3 percent, respectively (P < 0.0001). Infection by Gardnerella vaginalis could only be evaluated in the latter two decades. In 1988, 19.8 percent of the women had positive tests for Gardnerella vaginalis, which was the most frequent agent in that year, diminishing in the subsequent decade to 15.9 percent (P < 0.0001). Candidiasis was the most frequent infection in 1998, detected in 22.5 percent of the tests (P < 0.0001). In a general manner, all the infections were most frequent among younger patients, especially those aged under 20, in all decades, whereas infections were least frequent among patients aged 50 or over (P < 0.05). CONCLUSION: There was a reduction in the frequency of cervical-vaginal infection by Trichomonas vaginalis and an increase in the frequency of Candida sp over the four decades studied. All the infections were most frequent in patients aged under 20 years

Cyto-histological correlation of 219 patients submitted to surgical treatment due to diagnosis of cervical intraepithelial neoplasia

Cervical cytology continues to be the mostappropriate method for investigating cervical neoplasia and its precursors. Greater diagnostic acuity is obtained by combining cytology, colposcopy and guided biopsy methods. Objective: To analyze the diagnostic acuity of cyto-and histopathological exams and causes of diagnostic error. Design: Retrospective study. Setting: A public tertiary referral center. Sample: Reports on 219 patients submitted to cone biopsy and/or hysterectomy due to diagnosis of cervical intraepithelial neoplasia (CIN) in the period between January 1982 and March 1997 were reviewed, comparing. Main Measurements: cytological and histological exams (guided biopsy and surgically-removed tissue). In cases of discordance, the cyto-and histological preparations were reviewed to try to evaluate the causes of errors. Results: In 193 cases (88.1 per cent) there was cyto-histological agreement but none in 26 (11.9 per cent). Review of the discordant cases showed that in 2 (0.9 per cent) there was invasion of the stromata to a depth greater than 3 mm, and in 7 (3.2 per cent) microinvasion, unsuspected via cytology; in 2 (0.9 per cent) microinvasion was suspected via cytology but not confirmed by the final histological exam; and in 15 (6.8 per cent) there was disagreement about the degree of CIN. Conclusion: The principal causes of error in the cytological exam were the lack of reliable morphological criteria for microinvasion, absence of sampling of the squamocolumnar junction, and scarcity of neoplastic cells in the sample. As for the histological exam, the errors were related to inadequate technical processing and underestimation of focal lesions.

Persistência da infecçäo por papilomavírus humano: análise da idade, sexarca, cor, hábito de fumar e método contraceptivo / Persisting human papillomavirus infection: analyse of age, sexarch, race amd cigarette smoking and contraceptive methods

O objetivo deste estudo foi analisar um grupo de mulheres com alteraçöes citológicas compatíveis com infecçäo por papilomavírus humano (HPV), estudando a evoluçäo desta infecçäo, na tentativa de correlacionar com aspectos epidemiológicos como idade, sexarca, métodos contraceptivos, cor e hábito de fumar. Analisaram-se 507 mulheres entre janeiro a dezembro de 1991 com seguimento de 39 a 183 meses. Os resultados demonstraram que 66 (13 por cento) das mulheres permaneceram com sinais citológicos de infecçäo por HPV ou evoluíram para lesäo de alto grau após um período médio após um período médio de 48 meses. As outras 441 (87 por cento) das mulheres näo apresentaram nenhum sinal de infecçäo por HPV após esse tempo. Nossos dados mostraram que näo houve diferença estatísticamente significante entre o grupo de mulheres que permaneceu com a infecçäo e o grupo no qual os sinais citológicos de HPV näo foram detectados com relaçäo aos parâmetros avaliados