Prevalence and genotype distribution of human papillomavirus in non-neoplastic cervical tissue lesion: cervical erosion.

Human papillomavirus (HPV) infection is the commonest sexually transmitted infection, which is associated with various clinical conditions, ranging from asymptomatic infection to malignant disease of the cervix. The aim of this study was to evaluate the prevalence and genotypic distribution of HPV in women with cervical erosion and to compare the results with those in women with a clinically normal cervix. A further aim was to establish the association between HPV infection and cervical cytology results in women with and without cervical erosion. Cervical samples were collected by liquid-based method and consecutively evaluated for the presence of HPV DNA and for cervical cytology. HPV DNA was tested by a nested polymerase chain reaction (PCR) and typed by reverse dot blot genotyping. Cytological classification was made according to Bethesda 2001 criteria. The overall HPV prevalence was 16.9%; HPV DNA was positive in 20.2% of women with cervical erosion and 12.8% in women with normal cervix (P < 0.05). Multiple infections were found in 34.1% of the HPV-positive women. Commonest types were HPV 18 (32.9%), HPV 16 (29.5%), HPV 54 (20.5%), and HPV 6 (17%). Cervical cytology results were abnormal for 5.2% of women with cervical erosion and for 1.3% with clinically normal cervix (P < 0.05). This study detected a high prevalence of HPV infection in women with cervical erosion compared to women with a normal cervix. This data may contribute to the HPV epidemiology in the southeastern Turkey. It is recommended that women with cervical erosion should be given priority in HPV screening programs.

Recurrent mesh erosion and retropubic abscess following anterior intravaginal slingplasty.

Anterior intravaginal slingplasty (IVS), which utilizes multifilament polypropylene mesh is associated with significant risk of mesh erosion and infection. A case of mesh erosion occurred at 6 months following retropubic suburethral IVS sling was referred to our clinic. Complete removal of the protruded tape with primary closure of the vaginal defect was performed. However, repeat vaginal erosion was observed 2 years later. The undermined remaining tape further developed a retropubic purulent abscess. Thereafter, complete mesh removal and debridement in the retropubic space was carried out. The retropubic abscess resulted from the remains of the IVS tape. We emphasize that complicated sequel can develop after incomplete removal of IVS tape when tape erosion is encountered.

Cryotherapy as the treatment modality of postcoital bleeding: a randomised clinical trial of efficacy and safety.

BACKGROUND: Postcoital bleeding is a common gynaecological problem that impacts on a woman's quality of life and sexual function. There is little systematic research into its management. AIMS: To assess the efficacy and side-effects of cryotherapy as treatment for postcoital bleeding. METHODS: A prospective randomised controlled trial was conducted in a tertiary referral hospital in Hong Kong. A total of 85 women who presented with postcoital bleeding were recruited, and randomised to cryotherapy or no treatment. The treatment group received cryotherapy with compressed carbon dioxide through a cryoprobe placed on the cervix, and controls had cryoprobe on the cervix without compressed carbon dioxide flow. All recruited women were followed up two weeks, three months and six months to review their symptoms and response to the treatment. RESULTS: The treatment group had a significantly better long-term cure rate and improvement rate. At six months, the cryotherapy group reported a cure rate of 72.1% while that in the control group the cure rate was 50.0% (P = 0.04). The number needed to treat was 5. The mean improvement rate of the cryotherapy group was 82.88% +/- 35.87 but was only 61.62% +/- 55.30 in the control group (P = 0.04). The results were more significant in women with the defined pathological cervix. Apart from the vaginal discharge at second week follow up in the treatment group, there was no statistical significant difference in side-effects and complications among two groups. CONCLUSION: Our study demonstrated that cryotherapy is a safe and an effective treatment for postcoital bleeding.

Morbidity of the lower genital tract during pregnancy.

The lower genital tract of 280 pregnant women was studied in detail, and symptoms relevant to its morbidity were elicited and recorded. The study was contemporaneous with a study of microbial flora in the genital tract of these women (de Louvois et al, 1975). Complaint was made frequently of discharge (42%), irritation (15%), or both (11%). Apart from these symptoms, 14% admitted a past history of vulvovaginitis, emphasizing the importance of this condition in obstetric and gynaecological practice. The notorious discrepancy between the complaint, and the objective demonstration of discharge, was confirmed, but a significant difference in observations, varying with the clinical observer (P less than 0-001), was also demonstrated. This illustrates the necessity of even more accurate grading of signs when clinicopathological correlations are to be attempted. Only 30% of women had no evidence of vulvovaginitis or cervicitis. Morbidity did not relate to age, gestation or parity, but there was a significant correlation between clinical acumen, as evidenced by a request for a microbiological report with a view to treatment, and morbidity (P less than 0-001), between past vulvovaginitis and present morbidity (P less than 0-01), and between cervicitis and the presence of pus cells in the smear (P less than 0-001). The results indicate that microbiological investigations should be requested when there is past history of vulvovaginitis, and that lesions of the cervix, if not already noted, should be suspected if pus cells are demonstrable in stained smears.

Desquamative inflammatory vaginitis. A case report.

The differential diagnosis of noninfectious desquamative inflammatory vaginitis includes pemphigus vulgaris, erosive lichen planus and benign mucous membrane pemphigoid. A 32-year-old woman had persistent, noninfectious, erosive vaginitis and linear deposits of IgA in the vaginal epithelial basement membrane zone. The differential diagnosis should be expanded to include mucosal involvement by linear IgA disease, a cutaneous vesiculobullous disorder.

[Erosion of the uterine cervix in women with primary infertility treated with CO2 laser]. / Nadzerka szyjki macicy u kobiet z nieplodnoscia pierwotna leczona laserem CO2.

The authors described the results of treatment of erosions of the uterine cervix in 78 women with primary sterility with CO2-laser vaporisation in Department of Reproduction, Institute of Gynecology and Obstetrics, Academy of Medicine, Poznan. The results were estimated through clinical, cytological and colposcopical examinations in the term of 6 weeks and 3 months after therapy. The Insler's cervical mucus test was done in all women after 3 months. In all women the healing was achieved and five of them were needed for second laser therapy because of superficial endometriosis. The authors think that CO2-laser vaporisation (under colposcopical control) of erosions of the uterine cervix in women with primary sterility is the reliable method. The wound's healing after laser therapy is quick and without any complications. Laser therapy causes no trauma of the cervix structure and does not disturb in excretion of mucus by cervical glands.

Chlamydial infection of the cervix in contacts of men with nongonococcal urethritis.

An investigation of chlamydial infection in sexual contacts of patients with nongonococcal urethritis (NGU) was carried out to determine the clinical signs of infection in the cervix, and their response to chemotherapy, and the incidence of cervical infection in the presence of ectopy and oral contraception. In 202 consecutive female contacts of NGU the isolation rate of Chlamydia trachomatis was 35%. Hypertrophic ectopy and endocervical mucopus were present in 19% and 37% of chlamydia-positive patients respectively and, in all but one, resolved after treatment. Only 14% of those followed up after treatment developed yeast infections. The chlamydial isolation rate was significantly higher in patients with hypertrophic ectopy and endocervical mucopus. Cervical ectopy and oral contraceptives acted additively, each producing a significant effect on the chlamydial isolation rate in the presence of the other but not when present alone.