Topical treatment of flat vaginal condyloma with human leukocyte interferon.

Human leukocyte interferon cream was evaluated in a double blind placebo-controlled trial in 13 patients with widespread vaginal flat condylomatous dysplasia. Patients applied 12 million units of interferon vaginal cream daily into vagina during four two-week treatment courses separated by one-week intervals. Five of eight patients treated with interferon showed clear remissions in colposcopy. Cytologic examinations, however, revealed cells typical of condyloma in all cases. Two responding patients relapsed one and two months after the treatment. Among five patients using placebo, the lesions remained unchanged in three patients and progressed in two. Interferon treatment did not alter the microbiologic or cytologic picture of Papanicolaou smears, but lymphocytic infiltrations in the stroma next to condylomas were seen in histologic samples. No overt side effects were observed during interferon treatment.

Genital Chlamydia trachomatis infections in patients with cervical atypia.

Of 177 gynecologic outpatients with cervical dysplasia studied, 29 (16%) were found to excrete Chlamydia trachomatis from their urogenital tract. Sera collected from 93 of these patients were significantly more often positive for and showed higher levels of antichlamydial micro-complement fixation (CF) and immunofluorescence (IF) antibodies than sera obtained from the controls. However, when the sera were tested for anti-herpesvirus type II (HSV-II) and cytomegalovirus (CMV) antibodies, no difference between the cases and the controls were encountered.

Susceptibility of abortion patients to infection: Correlation to cervical flora.

Cervical bacterial microflora was studied with a semiquantitative method in 29 women both before and after the termination of their pregnancy. The main findings were high prevalence of anaerobic bacteria (in 72%-79% of the specimens) consisting predominantly of Bacteroides species and anaerobic Gram-positive cocci, and low prevalence of aerobic bacteria (in 24%-38% of the specimens). Among the other microbes studied, the prevalence of Chlamydia excretors was high (24%), probably reflecting a promiscuous study population. Seventeen percent of the women developed febrile postabortion endometritis or salpingits. However, the cervical culture results predicted neither the patient prone to infection nor her response to antimicrobial treatment, suggesting the need for more data concerning the virulence properties of the bacteria, together with isolation of the organism from an infected site.

Cytology of gynecologic condyloma acuminatum.

The morphology of certain cell types often encountered in vaginal and cervical smears of condyloma patients are described. These cells, considered to be exfoliated from epithelium affected by condyloma virus, were found in 60 per cent of the smears obtained from 192 women with condylomatat acuminata. Dysplasia of the cervical and vaginal epithelium is frequently associated with condyloma. Structural features typical of the condylomatous epithelium were common in these dysplasias. These lesions are probably also due to infection by condyloma virus, yet their significance is unknown and the possibility of a precancerous status cannot be ruled out except by a very long term follow-up study which is in progress. It may be assumed that this virus may affect the cervical and vaginal epithelium without any typical papillary condylomatous lesions resulting. Even in the absence of typical condylomatous papillary formations, the cytologic findings may reveal condyloma infection.

Clinical and virological findings in patients with cytologically diagnosed gynecologic herpes simplex infections.

Amoung 57,117 routinely collected Papanicolaou smears from the female genital tract there were 90 slides (0.16%) from 85 patients on which a cytologic diagnosis of herpes simplex virus (HSV) infection was made. The characteristic cytologic changes occurred predominantly on the ectocervical part of the smears. The changes were transient but occasionally remained detectable on the corresponding histologic specimens up to 2.5 months. Viral isolation was successful in a majority of cases when performed simultaneously with or less than a week after the cytologic diagnosis. The rate of success rapidly decreased thereafter. Positive fluorescent antibody assays of viral antigens on cytologic smears behaved similarly. Cases with apparent primary infection as well as with secondary infection (recurrences) were included in the material but no differences in the morphology of virally altered cells and be found, indicating that primary and secondary infections could not be distinguished on this basis. There were significantly more cytologic dysplastic changes as well as assorted micro-organism infections in the HSV group as compared to the controls.

Single dose of tinidazole in the treatment of vaginal discharge.

Seventy-nine unselected women whose main symptom was abnormal vaginal discharge were seen at the Department of Obstetrics and Gynecology at Helsinki University Central Hospital between October 1980 and September 1981. All patients and their current sex partners were randomly treated either with a 2-gram single dose of tinidazole or with identical placebos. Those excluded were 9 patients who did not attend the follow-up examination, 15 who had specific cervicovaginal infections (6 with chlamydial infection, 4 with trichomoniasis and 5 with yeast infection), and 22 with normal Döderlein flora seen on vaginal Pap smear. Response to the treatment was analysed among the remaining 33 women, of whom 17 received tinidazole and 16 placebo. The symptoms and signs that best discriminated between those who had normal Döderlein flora and those who had non-Döderlein flora were malodour, other than white colour of the discharge, and the presence of clue cells on Pap smear. When these findings were used to evaluate the response to treatment, tinidazole proved to be more effective than placebo. Disappearance of clue cells best (p less than 0.01) discriminated between tinidazole and placebo.

[Actinomycosis and IUD's]. / Aktinomykoosi ja kohtuehkäisin.

PIP: The use of IUDs can contribute to the incidence of actinomycosis. Actinomycosis, formerly regarded as a fungal disease, is now known to be caused by bacteria of the genus Actinomyces. The diagnosis of actinomycosis is difficult because the disease usually does not manifest itself in any specific symptoms. The most common diagnostic method uses histological slides. It is difficult to do cultures, and they require good anaerobic techniques. Pap smears are usually reliable but not unambigous since, in a heavy concentration of bacteria, Actinomyces may be mistaken for similar organisms. More specific results can be obtained using immunofluorescence. Before 1973, actinomycosis was considered a rare disease, a secondary one often resulting from an outbreak of appendicitis. Now it is commonly believed that women who have worn a plastic IUD for at least 2 years, and possibly women whose copper IUDs have not been changed for some time, are highly susceptible to actinomycosis. The 1st case of genital actinomycosis was discovered in 1973, with 10 cases reported in 1975 in which the patients had been using IUDs for at least 2 years. In 1979, 2 deaths from genital actinomycosis were reported. Also in 1979, a study reported actinomycosis in 19% of 330 women using IUDs. 1980 study found the disease in 40 of 128 women using plastic IUDs and 2 out of 165 women using copper IUDs for over 2 years. In Finland, physicians have always favored copper IUDs and frequent changes of any kind of IUD. A Swedish physician advocated in 1980 that all plastic IUDs be removed, that copper IUDs be changed frequently, and that no IUD be inserted if any gynecological infection is present. Annual pap smears are advisable and, only where necessary, antibiotics should be taken and IUDs removed. Actinomycosis can be cured with penicillin, tetracyclines, and erythromycin.^ieng

Cytologic findings in cervical chlamydial infection.

A study population of 240 young women who were sexual partners of men suffering from nongonococcal urethritis was investigated to establish whether it is possible, using routine cytology, to identify morphologic changed of diagnostic value in cervicitis due to Chlamydia trachomatis. Nonspecific severe inflammatory cellular atypias were significantly more frequent in the group of 93 C. trachomatis culture-positive women (38%) than in the control group of 147 C. trachomatis culture-negative women (18%). Tissue repair cells, appearing as a result of marked tissue destruction, were fond in 12% and in 3%, respectively. Intracytoplasmic inclusion bodies, pathognomonic of C. trachomatis, were not discovered in smears stained by papanicolaou's method. Hence, routine cytology is not the proper diagnostic method for chlamydial cervical infection. Dyskaryotic changes showing mild dysplasia occurred significantly more often in the C. trachomatis culture-positive women. This observation justifies the assumption that chlamydial infection may play a part in the development of dysplastic epithelial atypias of the cervix.

Effect of long-acting oestriol on the vaginal cytology of postmenopausal women.

Eight postclimacteric women were given 80 mg polyestriol phosphate by intramuscular injection in order to analyse the effect of the drug on the vaginal cytology. In four patients, whose vaginal smears showed complete atrophy before treatment, a clear but weak oestrogen effect was observed after the medication. This effect appeared after one week in three patients and after two weeks in one patient, and it lasted four weeks in three cases and two weeks in one. In four patients, whose vaginal smears showed a weak oestrogen effect before treatment, the therapy did not result in any significant change of the vaginal smear pattern.

Re-establishment of menstruation after abortion.

PIP: The sample consisted of 33 patients who had had abortions in the 7-18 week of pregnancy, except 1 case where the duration of pregnancy had been 25 weeks. In 21 cases legal interruption of pregnancy had been carried out. The remaining 12 came to the hospital after the onset of bleeding. Methods used for the determination of ovulation were measurements of the basal temperature, cytological smear, and single endometrial biopsy. The interval between abortions and the onset of menstruation was 25-64 days, the average being 39 days. Endometrial biopsies were done on all patients 16-39 days after ovulation. The first cycle after abortion was determined to be anovular in 25, and probably so in 4 others, while ovulation had occurred in 4. In the 21 patients having had therapeutic abortions ovulation had occurred in only 1 while in the 12 patients who had had spontaneous abortions ovulation occurred in 3. Histological findings were hyperplastic endometrium in 3, endometritis in 6 and retained fragments in 5. Check-up examination of 27 patients at the second menstrual period established that 15 had ovular cycles. Patients having legal abortion were routinely given 5 mg of estradiolbenzoate a day to a total of 10-15 mg. It is thought that this dose of estrogen may depress pituitary activity and thus disturb the mechanism leading to normal ovulation. Of 41 cytological vaginal smears 15 could not be analyzed owing to infection. All but 1 of the remaining showed results consistent with those obtained by biopsy.^ieng

Routine cytology as a diagnostic aid in chlamydial cervicitis.

The cytological abnormalities seen in connection with cervical inflammation due to Chlamydia trachomatis are briefly reviewed. Severe inflammatory changes and the occurrence of metaplastic cells and tissue repair cells, which are indicative of severe tissue damage, are common findings in chlamydial cervicitis. However, these changes may also be found in inflammatory states not caused by Chlamydia. Differentiation between the intracytoplasmic inclusions pathognomonic of chlamydial infection and the inflammatory degenerative cytoplasmic formations currently seen in exfoliated cervical cells cannot confidently be made from Papanicolaou-stained specimens. Routine cytology, therefore, is not the proper method for diagnosing chlamydial infection.

Oestrogenic activity associated with ovarian cystadenomas after the menopause.

In a group of 59 patients over the age of 55 years with ovarian serous and mucinous cystadenomas, a total of 29 (49%) showed moderate or strong oestrogenic activity as determined by maturation index in vaginal cytologic smears, in contrast to nine (13%) of 70 control patients with other gynecological disorders than ovarian tumours. The bacterial flora was dominated by Döderlein type bacilli in 24 of the 27 test patients with an elevated maturation index, also reflecting the abnormal oestogenic activity in these patients. When the serous and mucinous cystadenoma groups were compared, a striking difference was found: of the 30 patients with mucinous cystadenomas, 23 (77%) displayed moderate of strong oestrogenic activity, while this was the case with only six (21%) of the 29 patients with serous cystadenomas. These findings stress the importance of an abnormal oestrogenic activity, revealed by an elevated cytologic maturation index, as memento for the possibility of post-menopausal ovarian cystadenoma.

Prognostic significance of tissue carcinoembryonic antigen in mild dysplasia of the uterine cervix.

Two murine monoclonal antibodies to carcinoembryonic antigen (CEA) were used to detect CEA by the immunoperoxidase staining method in mild dysplasia of the uterine cervix in order to evaluate the prognostic significance of the expression of this antigen. The high affinity antibodies (Ha) detected CEA determinants in 53% of the 47 lesions studied while 40% of the epithelial changes were positive with the low affinity antibodies (La). Ha antibodies stained ten out of the 16 progressive lesions (62%), while La antibodies detected CEA determinants in 38% of these. Forty-eight per cent of the 23 regressive lesions were CEA positive with Ha and 39% with La antibodies respectively. The eight persistent lesions expressed CEA equally frequently (50%) with both antibodies. The results indicate that tissue CEA in patients with mild cervical dysplasia does not reflect malignant potential.

Condyloma and cervical epithelial atypias in young women.

One hundred and three adolescent women with cervical cytology suggestive of mild to moderate dysplasia were studied for the presence of condylomatous lesion. The analysis of smears revealed cells suggestive of condyloma in 81% of the cases. In histopathologic studies cervical lesions typical of condyloma were observed in 59 preparations. Of these 16 were papillary and 35 were flat condylomas, and in 8 cervices both papillary and flat condylomatous lesions were present. Colposcopic examination showed an atypical transformation zone in 57 cases. Papillary condylomas were present in 24 cervices in 7 cases combined with an atypical transformation zone. In addition to the cervical epithelial atypias there were 18 cases in which colposcopic and histologic examination of vagina revealed papillary warts, 13 of them combined with cervical condylomas. In four patients vaginal leucoplakia was seen and all were histologically flat condylomas. Thus, in 68 cases or in 66% of adolescent women having abnormal cervical cytology, histological investigation revealed condylomatous changes.

Volatile fatty acid findings in vaginal fluid compared with symptoms, signs, other laboratory results, and susceptibility to tinidazole of malodorous vaginal discharges.

The relevance of volatile fatty acids as a diagnostic test in 79 women with abnormal vaginal discharge was evaluated by a blind, randomised, and placebo controlled trial of tinidazole as a single oral 2 g dose. Automated gas chromatography of ether extracts of discharges taken before treatment showed volatile fatty acids in 18. Volatile fatty acids correlated with malodorous, colour, and microscopically assessed altered bacterial flora and clue cells. At follow up one week later, the odour, colour, and volatile fatty acids in the vaginal discharge of women treated with tinidazole had become normal more often than in those receiving placebo. The disappearance of volatile fatty acids correlated with clinically assessed improvement in women treated with tinidazole. The volatile fatty acid test as an indicator of anaerobic bacterial flora is objective, technically simple and fast, has few problems of sample size and transportation, and may be useful in the aetiological classification and follow up treatment of non-specific vaginal discharges.