HPV testing and Pap test: role for a combined approach in a non-screened population.

The aim of the present study was to test the polymerase chain reaction (PCR) as a tool to identify human papillomavirus (HPV) in routine cytological samples scraped from the uterine cervix. Moreover, attention has been focused on the correlation between HPV types and early intraepithelial lesions. The study involved 586 women who had undergone conventional Pap test. Analysis of HPV infection was performed by PCR and HPV typing by dot blot. In a group of 78 cases histologically diagnosed as high-grade squamous intraepithelial lesions (HSILs), the cytological diagnosis was correct in 92.3% and the HPV test was positive in 89.8% of cases; combined positivity at Pap and/or HPV tests raised this figure to 99.0%. In a group of 67 cases histologically diagnosed as low-grade squamous intraepithelial lesions (LSILs), the cytological diagnosis was correct in 73.1% and the PCR-based HPV test was positive in 64.2%; combined positivity at Pap and/or HPV tests raised this figure to 91.0%. This study confirms the limitations of screening programs based on Pap test only. Our results suggest, in fact, that adding the HPV test to primary screening could increase the yield of preinvasive cervical lesions.

Stress and cervical dysplasia.

The aim of the study was to evaluate the relationship between personality, stress and cervical dysplasia. Twenty women with cervical dysplasia were compared to a control group of 23 healthy women. An evaluation of their personality was made by the 16 PF questionnaire; stressing events were investigated with the Paykel scale; hormonal repercussions were studied by using serum and urinary cortisol titers. Significant differences were found in intellectual capability and fancifulness, as well as in cortisol levels. Considering the significant issues that have emerged, we feel that this research is worthy of further investigation and that new evaluation parameters are necessary.

Incidence of Chlamydia trachomatis in women with PID: effectiveness of therapy.

The pelvic inflammatory disease (PID) can be caused by various germs. Of the two thousand seven hundred thirty one women screened for different microbiological agents in the genitourinary tract and for PID, three hundred sixty nine patients were Chlamydia trachomatis (Ct) positive; one hundred and three patients were affected by PID. Seventy out of them were resulted to be Ct positive. One hundred twenty two women were Ct positive but not affected by PID. The antibiotic treatment resulted to be less effective in women Ct positive but affected by PID. Results of the present study demonstrate that Ct is the primary cause of PID.

The relationship between maternal relaxation and plasma beta-endorphin levels during parturition.

beta-endorphin (beta-EP) levels increase in maternal plasma starting from the 10th to the 12th week of pregnancy and reach a peak during labor and at delivery. Respiratory autogenous training (RAT) has been acclaimed as one of the most effective non-pharmacological methods of obtaining hypoalgesia and relaxing perineal muscles during labor. In order to study the effects of the RAT method in both maternal and fetal beta-EP levels during labor, 28 pregnant women were enrolled in this study. Fourteen attended a RAT program, while the others (control group) did not. beta-EP levels in both groups were measured in maternal plasma at early and late labor, at delivery and on the 4th day of the puerperium and in umbilical cord blood at birth. From late labor on, beta-EP maternal plasma levels increased significantly less in the RAT group than in the control group. The gap in the beta-EP levels between both groups was still significant at puerperium and in umbilical cord blood. In conclusion, the RAT method favorably modulates the secretion of beta-EP during labor and at delivery. This result supports the effectiveness of the RAT method in reducing both maternal and fetal stress during labor.

The couvade syndrome.

The couvade syndrome can be considered to be the psychosomatic equivalent of primitive rituals of initiation into paternity. Various symptoms have been described in the husbands of pregnant women with an incidence from 11% to 65%. The most common of these are: variations in appetite, nausea, insomnia and weight gain. Seventy-three couples with the women in the last month of pregnancy were given a questionnaire; as a reference group, 73 men without pregnant wives or children under 1 year of age were taken. An emotional involvement connected with pregnancy was reported in 91.78% of the men. This involvement was expressed as changes in sexual habits in 87.67% of cases, fear and anxiety in 36.98% and curiosity in 47.94%. With the exception of nausea, physical symptoms were less frequent in the men with pregnant wives than in those without pregnant wives. These data cannot confirm the existence of the couvade syndrome with its own physical symptoms but we think that some male experiences, which constitute a peculiar imaginary and behavioral reality of the father-to-be, do exist.

Epidemiology and therapy of Chlamydia trachomatis genital infection in women.

Out of 1172 females recruited in a screening program for genital infections, 144 (12.28%) were cervical and/or urethral positive for Chlamydia trachomatis (Ct) by enzyme immunoassay (EIA). Patients positive for Ct showed no significant differences in terms of demography, sexual practices and clinical evidence as compared to a control group formed by Ct-negative females randomly selected. Historical data showed a higher frequency of previous pelvic inflammatory disease (PID) in patients as compared to controls. 11 of the 94 patients' partners tested were sperm positive for Ct. Of the 63 patients for whom therapeutic data were available, 38 were treated with josamycin, 16 with tetracycline and the others with different drugs. After treatment, EIA for Ct was negative for 92.1% of the patients treated with josamycin and for 68.7% of those treated with tetracycline. The results of this study confirm a high prevalence of asymptomatic Ct infection which may be correctly diagnosed by EIA performed on cervical and urethral samples. They also indicate that negative test results can be obtained by an appropriate antibiotic treatment.

Isolation of Chlamydia trachomatis during IVF-ET.

The Authors isolated Chlamydia Trachomatis from the granulosa and from the spermatozoa of an infertile couple taking part in the IVF-ET program at the Department of Obstetrics and Gynaecology of the University of Pisa.

A possible role of Chlamydia trachomatis in unexplained infertility and sterility.

To estimate the presence of latent Chlamydia Trachomatis (C.T.) infections, we have carried out a study on a selected group of couples affected by unexplained sterility and infertility. We examined 193 women and, as control group 210 healthy fertile women. For both groups the main risk factors that could explain the infection epidemiology have been analyzed. The parameters considered are age of first intercourse, number of partners, social-economic conditions and number of voluntary abortions. Amongst all the causal agents of sexually transmitted diseases (STD), C.T. was most common, with an incidence of about 12 per cent in the study group versus the 5.7 per cent of the control group (chi 2 = 4.12).

PIP: The incidence of Chlamydia infection and factors associated with it in 193 women consulting for infertility was analyzed in comparison with 210 matched controls. All study subjects received a clinical exam, history interview, Pap test, vaginal bacteriology, colposcopy, cervical virology for Chlamydia and enzyme-linked assay for Chlamydia, herpes, rubella and toxoplasma antibodies. Results were tabulated as percent distributions for Chlamydia-positive and -negative in index cases and controls, broken down by the descriptive factors, age at 1st intercourse, number of partners, socio economic class and numbers of induced abortions. 43.5% of the index cases had primary infertility, 21.7% had secondary infertility and 34.8% were sterile. 11.9% of the study group were positive for Chlamydia infection, compared to 5.7% of controls. The only significant difference in factors related to STD infection were: earlier age at 1st intercourse among controls; higher percentage with 3 sexual partners, higher socioeconomic class and more induced abortions in the study group of infertile women; but no difference in chlamydia infection rates with abortion history. This study is unusual in finding higher socioeconomic class in the infertile women than in controls.

Typical and atypical lesions of herpes genitalis.

143 women with suspected Herpes Genitalis (HG), recurrent or common drug resistant vaginitis, unexplained or threatened abortion were examined by colposcopy, Pap test, viral culture and HSV-specific antibodies titration. HG was detected in 34 cases: 16 resulted positive for virus isolation. For the patients with negative culture HG was diagnosed by means of clinical examination, anamnesis and therapeutic criteria ex juvantibus. Serology proved to give little information. Most of the patients showed typical HG manifestations, but 8 of them were affected by atypical lesions. The infection proved to be not necessarily related to specific factors of risk, and it was not always possible to individuate the source of contamination. Only 9 out of the 33 sexual partners of the patients had asymptomatic manifestations. Many problems concerning HG diagnosis, epidemiology and therapy remain to be solved. The authors think that an engagement at different levels (population, practitioners, gynaecologists, politicians) is needed to face this issue fairly.

The therapy of verrucous carcinoma of the vulva. Observations on three cases.

Vulvar verrucous carcinoma is a distinct variant of squamous cell carcinoma, with a very low biological aggressiveness. Surgery is considered to be the elective treatment, even if there is no agreement in literature about the extent of surgical resection. Radiotherapy cannot be used in the management of this neoplasia. Sometimes this therapeutic modality induces an anaplastic transformation of the tumor, which can turn into a more aggressive malignancy. In this paper the clinical histories of 3 patients with vulvar verrucous carcinoma are discussed, in particular as regards therapy.

Incidence of dysplasia, carcinoma in situ and invasive carcinoma in colposcopic findings of atypical re-epithelization zone (A.R.Z.) and atypical transformation zone (A.T.Z.).

The Authors report their experience on 5518 colposcopic examinations and consider especially the findings of A.R.Z. and A.T.Z. and the correlation with cytologic and histologic aspects. They found a significant incidence of CIN (I, II, III) and invasive carcinoma by means of association of directed punch biopsies under colposcopic vision. Finally the importance of histological examination also in presence of negative cytologic findings is evidenced.

Is electrodiathermy coagulation (EDC) of cervical ectropion effective in the prevention of cervical carcinoma?

The Authors report their experience on the treatment of cervical ectropion by electrodiathermy coagulation (EDC). The effectiveness of this therapeutic approach in the prevention of cervical carcinoma is examined. Finally, it seems that this treatment can be a preventive measure of the precancerous lesions of the cervix, while it results unjustified the EDC treatment of cervical ectropion and TRZ .