Histopathology of endocervical infection caused by Chlamydia trachomatis, herpes simplex virus, Trichomonas vaginalis, and Neisseria gonorrhoeae.

We determined the histologic correlates of clinically identified mucopurulent cervicitis, culture-proven cervical infection with Chlamydia trachomatis, Neisseria gonorrhoeae, herpes simplex virus (HSV), and vaginal infection with Trichomonas vaginalis by examining cervical biopsies from 83 women. Clinical mucopurulent cervicitis and culture-documented infection with one or more of these pathogens correlated histologically with intraepithelial neutrophils, reactive endocervical cells, edema, luminal neutrophils, and with several deeper tissue changes such as extensive and dense subepithelial inflammation, granulation tissue, and necrotic ulceration. Focal loss of surface columnar cells and spongiosis were also correlated with culture-confirmed infection. Well-formed germinal centers were seen in biopsies from 14 of 21 patients (67%) with C trachomatis infection alone, but in none of 17 patients with infections other than C trachomatis (P less than 0.001). A predominantly plasmacytic infiltrate was also significantly associated with chlamydial infection. Necrotic ulcers overlying a predominantly lymphocytic infiltrate were seen in six of nine patients (67%) with HSV infection alone but in only two of 40 patients (5%) with other infections (P less than 0.001). Marked inflammatory changes were not seen in the patients infected with N gonorrhoeae. The organism T vaginalis was not associated with any endocervical pathology. If these results are confirmed by prospective studies, they suggest that pathologists should alert clinicians to the possibility of recent or current infection with C trachomatis or HSV when cervical biopsies show the above changes. The loss of surface columnar epithelium with HSV, chlamydial, and gonococcal infection offers a possible explanation for the reported association of these infections with increased risk of acquiring human immunodeficiency virus infection.

Endometrial histopathology in patients with culture-proved upper genital tract infection and laparoscopically diagnosed acute salpingitis.

To define and quantitate histologic changes in the endometrium that best correlate with documented upper genital tract infection (UGTI) and laparoscopically diagnosed acute salpingitis, we studied endometrial biopsy specimens from 69 consecutive patients with clinically suspected acute pelvic inflammatory disease (PID) who underwent microbiological evaluation for UGTI and laparoscopic examination for acute salpingitis. Both UGTI and acute laparoscopically confirmed salpingitis were present in 37 patients (54%), UGTI without salpingitis in 1 (1%), salpingitis without UGTI in 11 (16%), and neither UGTI nor salpingitis in 20 (29%). Chlamydia trachomatis or Neisseria gonorrhoeae UGTI was found in 34 women, Escherichia coli in two patients, Peptococcus magnus in one woman, and with Streptococcus agalactiae in one woman. The following features were correlated both with UGTI and with salpingitis: presence of any neutrophils in the endometrial surface epithelium; neutrophils within gland lumens; dense subepithelial stromal lymphocytic infiltration; any stromal plasma cells; and germinal centers containing transformed lymphocytes. The simultaneous presence of five or more neutrophils per X 400 field in endometrial surface epithelium, together with one or more plasma cell per X 120 field in endometrial stroma, was the best predictor of UGTI plus salpingitis. This combination had a sensitivity of 92% and a specificity of 87% for predicting the diagnosis of both UGTI and laparoscopically confirmable acute salpingitis. Prospective studies are needed to assess the usefulness of these criteria.

Prevalence of genital papillomavirus infection among women attending a college student health clinic or a sexually transmitted disease clinic.

We examined 454 women randomly selected from a Sexually Transmitted Disease (STD) Clinic and 545 consecutive college women undergoing annual examination. Patients were examined for visible genital warts, koilocytes, and human papillomavirus (HPV) antigen on cervical smears and for cervical HPV DNA types 6, 11, 16, 18, and 31. Genital warts were found in 11% of STD Clinic patients and 2% of students (P less than .001). Among those women without genital warts, HPV DNA or antigen was detected in cervical specimens from 10.6% of STD Clinic patients and 11.4% of students (P = .73), with HPV type 16, 18, or 31 being 9.8 times more frequent than cervical HPV 6 or 11 among students and 5.8 times more frequent among STD Clinic patients. Dysplasia was present in 53% of those with HPV type 6 or 11 and in 41% of those with HPV type 16, 18, or 31 DNA.

Cytologic manifestations of cervical and vaginal infections. I. Epithelial and inflammatory cellular changes.

We used multiple logistic regression to analyze microbiological and clinical correlates of inflammatory and epithelial cell changes on Papanicolaou-stained cervical smears in patients from a sexually transmitted disease clinic. Among randomly selected patients, increased numbers of histiocytes and polymorphonuclear leukocytes and the presence of transformed lymphocytes were associated with Chlamydia trachomatis infection, while increased lymphocytes were associated with Trichomonas vaginalis infection; minimal squamous atypia was associated with yeast infection; and moderate squamous atypia and koilocytosis were associated with cervical condylomata visualized by colposcopy. Among patients referred for cervicitis, C trachomatis infection was also associated with reactive or atypical metaplastic cells. Distinct inclusions were seen by Papanicolaou smear in only 22% of C trachomatis infections. In randomly selected patients, however, the presence of transformed lymphocytes or increased histiocytes had a sensitivity of 95%, a specificity of 75%, and a positive predictive value of 50% in relation to isolation of C trachomatis, and could therefore be used for selection of patients for confirmatory testing for C trachomatis infection.

Steroids in ovarian and peripheral venous blood in polycystic ovarian disease.

Ovarian and peripheral venous blood samples were collected at operation in six patients with polycystic ovaries (PCO) and seven control subjects with normal ovarian function in the follicular phase of the cycle. Plasma concentrations of unconjugated testosterone, dihydrotestosterone (DHT), androsterone, androstenedione, dehydroepiandrosterone (DHEA), pregnenolone, progesterone, 17 alpha-hydroxyprogesterone (17 alpha-OH-P) and oestradiol were determined by specific radioimmunoassay techniques, and concentrations of DHEA, androsterone and pregnenolone sulphates by gas chromatography. In the control group, ovarian vein concentrations of all unconjugated steroids, except progesterone, were significantly higher than the corresponding peripheral vein concentrations, suggesting ovarian secretion. No significant differences were demonstrated between ovarian and peripheral plasma levels of steroid sulphates. Ovarian vein levels of androstenedione, testosterone and DHEA were markedly elevated in PCO patients compared with the control group, and the levels of DHT and androsterone to a lesser degree. Polycystic ovaries appear to secrete androsterone sulphate, but no significant secretion of DHEA sulphate could be demonstrated. Ovarian venous levels of oestradiol in the PCO group did not differ from those in the control group. Elevated ovarian venous androgen levels in the PCO group seemed to correlate with thecal cell hyperplasia as indicated by histological examination of ovarian biopsies. In one PCO patient, blood levels of different steroids were followed for a month after ovarian wedge resection. Testosterone fell to half the pre-operative value and a temporary fall was also noticed in other androgens. A marked rise in plasma progesterone concentration at the end of the follow-up period suggested that ovulation had occurred.

Infertility and cervical Chlamydia trachomatis infections.

Of the 51 women examined for infertility, 19.6 per cent were found Chl. trachomatis culture-positive. This differs, although not significantly, from the 9 per cent isolation rate among our general gynecological outpatients. The results suggest that Chl. trachomatis should be considered in women with unexplained infertility.

PIP: 51 consecutive infertility patients were tested for the presence of Chlamydia trachomatis in the cervix. Of the 51 subjects studied, 10 (19.6%) excreted C. trachomatis. The mean age of patients was 29.1 years (range, 22-38). This 19.6% rate differed, but not significantly, from the 9% isolation rate among the general gynecological outpatients. No abnormalities of the cervix were observed among chlamydia-positive patients. In 3 cases the vaginal smear taken for hormonal test showed inflammatory reaction. Distribution of known etiological factors of infertility was rather similar in the 2 patient groups (i.e., culture positive and culture negative), except that the etiology of infertility remained unexplained in 5/10 chlymadia-positive patients, but in only 7/41 (17%) negative patients. This difference was not statistically significant (P .1). These data suggest that C. trachomatis should be considered in women with unexplained infertility.