Clinical efficacy of thermocoagulation in women with biopsy-confirmed cervical low-grade squamous intraepithelial lesions (LSILs) or less after colposcopy referral.

OBJECTIVES: To evaluate the clinical efficacy of thermocoagulation in women with biopsy-confirmed cervical low-grade squamous intraepithelial lesions (LSIL) or less after colposcopy referral. MATERIAL AND METHODS: A longitudinal study was performed. Women who were diagnosed with cervical LSIL or chronic cervicitis underwent scheduled follow-up examinations with cytology and human papilloma virus (HPV) genotyping for two years after the initial management with thermocoagulation or observation without treatment. All women underwent scheduled follow-up with combined cytology and HPV test at 6th months, 12th months, and 24th months after the initial management. Both HPV clearance and cytological regression were included in the analysis, with clinical cure defined as normal cytology and negative HPV results. RESULTS: A total of 221 women were included. The histopathological results identified 136 (61.54%) patients with LSIL and 85 (38.46%) with chronic cervicitis. Of these, 113 (51.13%) received thermocoagulation therapy, and 108 (48.87%) chose observation. The 2-year follow-up rate was 91.40%. Women who received thermocoagulation presented a significantly higher probability of cure for two years than those who chose observation (62.86% vs 39.18%, p < 0.001). This preponderance was not observed in the subgroup analysis regarding women with cervical cervicitis (54.17% vs 41.38%, p = 0.277) but was observed in women with LSILs (70.18% vs 38.24%, p < 0.001). CONCLUSIONS: Thermocoagulation may be indicated for patients with cervical LSILs as an effective outpatient procedure in clinical practice.

[Correlation and clinical significance of VISTA expression and cervical squamous cell carcinoma].

Objective: To explore the relationship between the expression of the T-cell activation suppressor-immunoglobulin variable region (VISTA) and the development of cervical squamous cell carcinoma (CSCC), and the impact on the prognosis of CSCC patients. Methods: Cervical tissue samples from 116 CSCC, including 23 cervical intraepithelial neoplasia (CIN) grade I, 23 CIN grade Ⅱ-Ⅲ, and 23 chronic cervicitis patients, were collected from the First Hospital of Soochow University between March 2014 and April 2019. The expression of VISTA in each group was detected by immunohistochemistry (IHC). Survival data of CSCC patients were obtained by follow-up. The survival analysis was performed by Kaplan-Meier method, and survival differences between groups were compared by Log rank test. Prognostic impact factors were analyzed using a multifactorial Cox proportional hazards model. Results: The positive rate of VISTA expression in CSCC group was 32.8% (38/116), and which of grade Ⅱ-Ⅲ was 17.4% (4/23). VISTA expression results showed no positive expression patients in the cervical intraepithelial neoplasia grade I and chronic cervicitis groups. The differences between the CSCC group and other groups were statistically significant (P<0.01). In 116 CSCC patients, VISTA expression was associated with International Federation of Gynecology and Obstetrics (FIGO) stage and lymph node metastasis (P<0.01). The mean survival time of patients in the VISTA positive expression group was 30.7 months, and the 3-year survival rate was 44.7% (17/38). However, the mean survival time of the patients in the VISTA negative expression group was 49.1 months, and the 3-year survival rate was 87.2% (68/78). The Cox regression model found that VISTA expression positivity (P=0.001) and FIGO stage (P=0.047) were prognostic factors for CSCC, and patients with VISTA-positive CSCC had a 4.130-fold risk of death higher than those with VISTA-negative expression. Conclusions: The VISTA protein is highly expressed in CSCC tissues, and its expression level is closely related to the occurrence and development of CSCC. The expression of VISTA can be used as an independent predictor of CSCC prognosis and can provide a strong basis for the treatment of CSCC with immune checkpoint inhibitors.

Histomorphological Evaluation of Non-Neoplastic Lesions of Uterine Cervix and a Correlation of the Lesion with the Clinical Factors.

AIM: This study investigates the prevalence of non-malignant lesions of the cervix among various biopsy samples. METHODS: This case study consists of 50 cases of cervical biopsy over almost two years. The case history and clinical details of the patients were obtained. RESULTS: 60% of the cases that participated in this study reported white discharge per vaginum as a common clinical symptom. 4 cases (8%) showed koilocytic changes specific to the human papillomavirus during the study. Only 2% of the non-specific cervicitis showed lymphoid aggregates. Endocervical changes projected papillary endocervicitis with 9 cases (18%), squamous metaplasia with 7 cases (14%), and nabothian follicle cyst with 3 cases (6%). CONCLUSION: It has been concluded that 50 cases were studied histologically, which had adequate representation of both ecto and endocervical tissue. Moreover, 31-40 years of age of patients showed the highest percentage of non-neoplastic lesions of the cervix when compared to other age groups.

A micro-Raman spectroscopy study of inflammatory condition of human cervix: Probing of tissues and blood plasma samples.

The present study explores the application of the micro-Raman spectroscopy technique to discriminate normal and cervicitis condition from cervical malignancy by analyzing the Raman signatures of tissues and plasma samples of the same subjects. The Raman peaks from tissue samples at 1026 cm-1,1298 cm-1 and 1243 cm-1 are attributed to glycogen, fatty acids and collagen and are found to be reliable signatures capable of identifying cervicitis and normal condition from cervical cancer. The Raman signatures from plasma samples belonging to carbohydrates (578 cm-1), lipids (1059 cm-1) and nucleic acids (1077 cm-1,1341 cm-1 and 1357 cm-1) are quite useful to classify various pathological conditions of cervix at par with tissue based diagnosis. The PCA-SVM based classification of the spectral data indicates the potential of Raman spectroscopy based liquid biopsy to rule out false diagnosis of cervicitis as cervical malignancy.

Expanded Histopathology and Tropism of Ebola Virus in the Rhesus Macaque Model: Potential for Sexual Transmission, Altered Adrenomedullary Hormone Production, and Early Viral Replication in Liver.

The pathogenesis of Ebola virus disease (EVD) is still incomplete, in spite of the availability of a nonhuman primate modelfor more than 4 decades. To further investigate EVD pathogenesis, a natural history study was conducted using 27 Chinese-origin rhesus macaques. Of these, 24 macaques were exposed intramuscularly to Kikwit Ebola virus and euthanized at predetermined time points or when end-stage clinical disease criteria were met, and 3 sham-exposed macaques were euthanized on study day 0. This study showed for the first time that Ebola virus causes uterine cervicitis, vaginitis, posthitis, and medullary adrenalitis. Not only was Ebola virus detected in the interstitial stromal cells of the genital tract, but it was also present in the epididymal and seminal vesicular tubular epithelial cells, ectocervical and vaginal squamous epithelial cells, and seminal fluid. Furthermore, as early as day 3 after exposure, Ebola virus replicative intermediate RNA was detected in Kupffer cells and hepatocytes. These findings in the nonhuman model provide additional insight into potential sexual transmission, possible disruption of sympathetic hormone production, and early virus replication sites in human EVD patients.

A novel visceral pain model of uterine cervix inflammation in rat.

Treatment of visceral pain originating from the uterine cervix is a substantial clinical problem. The underlying mechanisms of such visceral pain remain unclear mainly due to a lack of reliable model. This study aimed to develop and evaluate the performance of a rat model of pain induced by uterine cervix inflammation. Rats were randomized to six groups according to the solution injected into the uterine cervix: normal saline, vehicle, capsaicin (0.3 mg, 0.6 mg, 0.9 mg), capsaicin 0.9 mg + morphine (n = 15 in each group). Spontaneous behaviors after cervical injection were recorded by a computerized video system and analyzed offline. An equation for calculating a novel pain score was derived from particular behaviors, based on Pearson's correlation analysis and regression analysis. c-Fos expression in the spinal cord was detected. The pain score and c-fos expression in the spinal cord were highest in the 0.9 mg capsaicin group and lowest in the normal saline and vehicle groups (P < 0.05). Intrathecal morphine significantly decreased the pain score (P < 0.05) and c-fos expression in the spinal cord (P < 0.05). Injection of capsaicin into the uterine cervix in rats could be a practical model of inflammatory cervical pain, which can be evaluated using our novel pain score. This model will provide further insight into the mechanism underlying visceral pain originating from the uterine cervix.

Cervical Cytology of Samples with Ureaplasma urealyticum, Ureaplasma parvum, Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma hominis, and Neisseria gonorrhoeae Detected by Multiplex PCR.

INTRODUCTION: Despite increasing application of molecular diagnostic methods for the detection of sexually transmitted infections, the cytological findings in pap smears of patients with pathogens that can be identified only by PCR are not yet well described. The aim of this study was to describe the most common cytological features in cervical pap smears of patients with Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum detected by multiplex PCR. METHODS: Cervical samples for conventional and liquid-based cytology and for multiplex PCR were collected from women ranging from 23 to 54 years old, who underwent routine screening at a gynecological Unit. RESULTS: Multiplex PCR was positive in 36.2% of the samples: Ureaplasma parvum 14.9%, Chlamydia trachomatis 10.6%, Trichomonas vaginalis 10.6%, Mycoplasma hominis 8.5%, Ureaplasma urealyticum 4.2%, Neisseria gonorrhoeae 2.1%, and Mycoplasma genitalium (0). Multiple pathogens were observed in 12.8% of samples. Microscopic cervicitis (≥10 polymorphonuclear leukocytes/epithelial cell) and normal (predominantly lactobacillary) microbiota were the most frequent findings in the samples in which the pathogens were detected alone or in multiple infections, except for samples with Trichomonas vaginalis in which the coccobacillary microbiota was the most common. In samples with microscopic cervicitis and normal microbiota, those with at least one pathogen identified by multiplex PCR were significantly more frequent than those with no pathogen, 66.6% versus 33.3%. CONCLUSION: Failure to identify an inflammatory agent in pap smear with intense neutrophil exudate may suggest the presence of Ureaplasma parvum, Ureaplasma urealyticum, Chlamydia trachomatis, or Trichomonas vaginalis. A remark on the intensity of inflammation should be made in the reports of cervical pap smears so that this cytological finding can be correlated with clinical and PCR results.

HPV genotypic spectrum in Jilin province, China, where non-vaccine-covered HPV53 and 51 are prevalent, exhibits a bimodal age-specific pattern.

BACKGROUND: Human papillomavirus (HPV), the most common sexually transmitted disease, is involved in a series of other diseases. The persistent infection of high-risk HPVs (HR-HPVs) is considered to be the causative agent of cervical cancer, and it is related to noncervical cancers. The present study aims to estimate the HPV prevalence and genotype distribution in Jilin province, China, to guide HPV-related cervical cancer screening and HPV vaccination. METHODS: From October 2017 to September 2019, 21,282 samples (634 male and 20,648 female) were collected for HPV infection detection using an HPV genotyping panel. The age-related HPV prevalence and morbidity of HPV-based disease and HPV prevalence associated with specific diseases were analyzed. RESULTS: A total of 7095 (34.4%) positive for HPV infection of 20648 women, and 164 (25.8%) positive of 634 men. The HPV prevalence among women exhibited a bimodal pattern, with a peak in young group and a second peak in old group, with increased severity of cervical lesions. HPV16 (7.8%), HPV52 (5.8%), HPV58 (5.0%), HPV53 (3.4%), and HPV51 (3.0%) were the most prevalent genotypes among women, and HPV6 (6.0%), HPV11 (5.7%), HPV16 (3.6%), HPV18 (2.7%), and HPV51 (3.0%) were prevalent among men. Non-vaccine-covered HPV53 and 51 were found in 6.3% of HPV infection and 8.9% of cervical cancer in Jilin province. Furthermore, 45.5% of females and 28.6% of males with genital warts were infected with HR-HPV genotypes. CONCLUSION: The HPV genotypic spectrum in Jilin province, where non-vaccine-covered HPV53 and 51 were prevalent, exhibited an age- and cervical lesion-specific pattern, which provides guidance for HPV vaccination and cervical cancer screening. HPV infection in men and benign hyper-proliferative lesions should not be neglected.

ULTRASOUND DIAGNOSTICS OF CERVICAL CHANGES WITH DIFFERENT LOCALIZATION OF THE CERVICITIS IN WOMEN WITH THE ECTOPY OF THE VAGINAL PORTION OF THE CERVIX.

The aim of the study was to improve the diagnosis of structural changes in all parts of the cervix depending on the preferential localization of the inflammatory process - in the ectocervix, endocervix, and also in the stroma in women with ectopia (pseudoerosis) of the vaginal part of the cervix. The study included women of predominantly early and middle reproductive age, as these women have inflammatory processes more often than in menopause. To perform the work, a transvaginal imaging method was used, which allowed us to see the smallest structures (up to 0.5-1.0 mm) of the cervix. We have previously developed a technique for visualizing the external part of the cervix and obtained a patent of Ukraine. The results of the ultrasound were compared with laboratory data, colposcopy and cervicoscopy. Traditionally, the diagnosis of cervicitis was made on the basis of clinical symptoms, smear results to determine the presence and type of pathogen. Endoscopic methods allowed visualization of only the mucous membrane of the cervical canal and external part of the cervix. The deep layers of the ectocervix, endocervix and cervical stroma can only be visualized using high-frequency ultrasound in a transvaginal way. According to the results of the study, it was possible to determine the preferential localization of the inflammatory process, to determine the nature of changes in different layers of the cervix. These changes were expressed in the presence of calcifications and cystic cavities of various sizes (1-6 mm), an increase or decrease in echogenicity, the degree of heterogeneity of the structure of the ecto-, endocervix and stroma.

Radiation induces changes in toll-like receptors of the uterine cervix of the rat.

Radiotherapy is an important therapeutic approach against cervical cancer but associated with adverse effects including vaginal fibrosis and dyspareunia. We here assessed the immunological and oxidative responses to cervical irradiation in an animal model for radiation-induced cervicitis. Rats were sedated and either exposed to 20 Gy of ionising radiation given by a linear accelerator or only sedated (controls) and euthanized 1-14 days later. The expressions of toll-like receptors (TLRs) and coupled intracellular pathways in the cervix were assessed with immunohistofluorescence and western blot. Expression of cytokines were analysed with the Bio-Plex Suspension Array System (Bio-Rad). We showed that TLRs 2-9 were expressed in the rat cervix and cervical irradiation induced up-regulation of TLR5, TRIF and NF-κB. In the irradiated cervical epithelium, TLR5 and TRIF were increased in concert with an up-regulation of oxidative stress (8-OHdG) and antioxidant enzymes (SOD-1 and catalase). G-CSF, M-CSF, IL-10, IL- 17A, IL-18 and RANTES expressions in the cervix decreased two weeks after cervical irradiation. In conclusion, the rat uterine cervix expresses the TLRs 2-9. Cervical irradiation induces immunological changes and oxidative stress, which could have importance in the development of adverse effects to radiotherapy.

An immunohistochemistry and histopathological study of ankaferd blood stopper in a rat model of cervical inflammation.

OBJECTIVE: Ankaferd Blood Stopper (ABS) is a medicinal plant extract used topically as a hemostatic, anti-inflammatory, and anti-oxidant agent. Its cytoprotective effect mainly depends on its pleiotropic properties by modulating inflammatory mediators such as IL-1ß, IL-6, and TNF-α. This study aims to test the possible therapeutic effect of ABS in the treatment of erosive and inflammatory conditions occurring in the uterine cervix. METHODS: Twenty-four female Wistar Albino rats were used in the present study. Trichloracetic acid was applied intravaginally to establish an experimental rat model of cervicitis. The rats were randomly divided into three groups: group I (injury), group II (injury+isotoinc saline), and group III (injury+ABS). After 3 estrous cycles of ABS and isotonic saline treatment, the amount of inflammation, vascular congestion and erosion were evaluated in the cervical tissues by using a modified semi-quantitative scale of 0-3. Immunohistochemical staining with monoclonal antibodies against IL-1ß was also performed. RESULTS: Compared with group I and II, the ABS group showed the least inflammatory cell infiltration, vascular congestion and cervical erosion, compared with the ABS group prominent IL-1ß staining observed in group I and group II. CONCLUSION: Our data suggest that ABS is a highly effective alternative to induce normal cervical epithelium and can be used safely in the treatment of cervical inflammation with or without cervical erosion.

An immunohistochemistry and histopathological study of ankaferd blood stopper in a rat model of cervical inflammation

SUMMARY OBJECTIVE: Ankaferd Blood Stopper (ABS) is a medicinal plant extract used topically as a hemostatic, anti-inflammatory, and anti-oxidant agent. Its cytoprotective effect mainly depends on its pleiotropic properties by modulating inflammatory mediators such as IL-1β, IL-6, and TNF-α. This study aims to test the possible therapeutic effect of ABS in the treatment of erosive and inflammatory conditions occurring in the uterine cervix. METHODS: Twenty-four female Wistar Albino rats were used in the present study. Trichloracetic acid was applied intravaginally to establish an experimental rat model of cervicitis. The rats were randomly divided into three groups: group I (injury), group II (injury+isotoinc saline), and group III (injury+ABS). After 3 estrous cycles of ABS and isotonic saline treatment, the amount of inflammation, vascular congestion and erosion were evaluated in the cervical tissues by using a modified semi-quantitative scale of 0-3. Immunohistochemical staining with monoclonal antibodies against IL-1β was also performed. RESULTS: Compared with group I and II, the ABS group showed the least inflammatory cell infiltration, vascular congestion and cervical erosion, compared with the ABS group prominent IL-1β staining observed in group I and group II. CONCLUSION: Our data suggest that ABS is a highly effective alternative to induce normal cervical epithelium and can be used safely in the treatment of cervical inflammation with or without cervical erosion.

RESUMO OBJETIVO: Ankaferd Blood Stopper (ABS) é um extrato de plantas medicinais utilizado topicamente como um agente hemostático, anti-inflamatório e antioxidante. O seu efeito citoproteico depende principalmente das suas propriedades pleiotrópicas por meio da modulação de mediadores inflamatórios tais como IL-1β, IL-6 e TNF-a. O objetivo deste estudo é testar o possível efeito terapêutico do ABS no tratamento de condições erosivas e inflamatórias que ocorrem no colo uterino. MÉTODOS: Vinte e quatro ratas Wistar Albino foram utilizadas no presente estudo. O ácido tricloroacético foi aplicado intravaginalmente para estabelecer um modelo experimental de cervicite em ratos. Os ratos foram divididos aleatoriamente em três grupos: grupo I (lesão), grupo II (lesão + fisiológico sérico) e grupo III (lesão + ABS). Após três ciclos estrais de ABS e tratamento fisiológico sérico, as quantidades de inflamação, congestionamento vascular e erosão foram avaliadas nos tecidos cervicais usando uma escala semiquantitativa modificada de 0-3. Coloração imuno-histoquímica com anticorpos monoclonais contra IL-1β também foi realizada. RESULTADOS: Em comparação com os grupos I e II, o grupo ABS mostrou menos infiltração de células inflamatórias, congestionamento vascular e erosão cervical. Além disso, em comparação com o grupo ABS, observou-se uma coloração proeminente de IL-1β no grupo I e no grupo II. CONCLUSÃO: Nossos dados sugerem que o ABS é uma alternativa altamente eficaz para induzir o epitélio cervical normal e pode ser utilizado com segurança no tratamento da inflamação cervical com ou sem erosão cervical.

Expression of AMHR2 and C-KIT in cervical lesions in Uyghur Women of Xinjiang, China.

BACKGROUND: Cervical cancer is one of the most common malignant tumors in women. Anti-Müllerian hormone receptor 2 (AMHR2) and C-Kit were two members of protein kinase which were reported increased in some cancers like ovarian carcinoma and breast cancer. The present study aimed to assess the expression of AMHR2 and c-Kit in cervical cancer of different differentiated degrees as well as in cervicitis sections. METHODS: All the lesions were collected randomly during clinical observations in hospitals located in Xinjiang, China. Polymerase chain reaction (PCR) and immunohistochemical staining were used to detect AMHR2 and c-Kit expression in cervical samples from women who had been infected with human papilloma virus (HPV)16. The expression rate was compared between cervical cancer of well, moderately and poorly differentiated and cervicitis. RESULTS: The average age of the patients was 45 years; ranged from 23 to 80. For AMHR2, all 17 cervicitis samples ranged from (++) to (++++), while cervical cancer showed 11 (+), 9 (++), 15 (+++),9 (++++), and 8 (-), which showed AMHR2 expression was lessen with the poorer of differentiation degree of cervical cancer (P < .05). For c-Kit, 18 cervicitis samples mainly expressed as (-) with none showed (+++) or (++++), while cervical cancer samples showed 7 (-), 6 (+), 1 (++), 2 (+++), and 8 (++++), which indicated c-Kit's expression increased with the reduction of cervical cancer's differentiation degree (P < .05). CONCLUSION: AMHR2 might have some correlation with self defense of our body, while c-Kit might link with the potential invasive capacity of cervical cancer.

Irreversible electroporation of the uterine cervix in a rabbit model.

The aim of this study was to evaluate the effects of irreversible electroporation (IRE) on the uterine cervix in a rabbit model. IRE ablation was performed in the cervices of 48 New Zealand rabbits, with one ablation lesion in each animal. Gross pathology, transmission electron microscopy, hematoxylin and eosin (H&E), Masson's trichrome (MT) stain, and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assays were performed at pre-set time points (0 h, 12 h, 1 d, 2 d, 4 d, 7 d, 14 d, and 28 d post-IRE). All the rabbits tolerated the IRE ablation without serious complications. IRE caused complete cell death of the ablated cervix via cell apoptosis. However, fast recovery of the cervix was observed from 7 d post-IRE, with the signs of collagen fibers hyperplasia, the disappearance of the necrotic cells and muscle fibers, and regeneration and extension of the cervical epithelium. At 28 d post-IRE, the ablated cervices recovered to almost normal. Our study suggested that IRE might be an efficient and safe technology to treat cervical tumors, without causing serious cervical damage.

Comorbidity profiles among women with postcoital bleeding: a nationwide health insurance database.

PURPOSE: Most of the existing studies on postcoital bleeding (PCB) in Western countries. To date, no study has focused on the various PCB-related comorbidities in Taiwan women. This work aims to analyze and compare the presence or absence of PCB among Taiwanese women with gynecological comorbidity. METHODS: This study is a population-based retrospective cohort investigation. Outpatients with PCB after the index date were considered. A total of 2377 female patients with PCB (ICD-9 626.7) were identified using a nationwide outpatient sample from 2001 to 2010. For comparison, 7131 cases were randomly matched with the study group in terms of gender and age. RESULTS: The PCB incidence rate was 39-59 cases/100,000 Taiwanese women, with mean age (±SD) of 36.74 ± 10.79 years, median age of 36 years, and mode age of 29 years. Women with PCB exhibited 1.47-fold risk of cervical dysplasia and 1.59-fold risk for malignant neoplasm of cervix. Young women with PCB showed high risk of cervical cancer. The most common benign diseases among PCB- related comorbidities were cervical erosion and ectropion (20.66%), followed by vaginitis and vulvovaginitis (19.18%). Comparison between PCB and non-PCB groups indicated several significant high-risk comorbidities including cervical polyps, cervical erosion, leukoplakia of cervix, intrauterine contraceptive device, cervicitis, vaginitis, menopause, dyspareunia, and vulvodynia. CONCLUSIONS: This study provides evidence that PCB-related comorbidities manifested benign diseases (51.58%), lower genital tract infection (46.11%), and cervical cancer (2.31%). Thus, healthcare providers must ensure that appropriate routine screening tests and counseling are given to women with PCB.

Effect of Dialyzable Leukocyte Extract on chronic cervicitis in patients with HPV infection.

The objective of the study was to assess the clinical, histopathological and immunochemical changes induced by dialyzable leukocyte extract (DLE) treatment in patients with chronic cervicitis associated to HPV infection. Fifty-four female Mexican patients diagnosed with chronic cervicitis, cervical intra-epithelial neoplasia grade 1 (CIN 1) and HPV infection were divided into two groups: patients treated with placebo and patients treated with DLE. Clinical and colposcopy evaluations were performed before and after treatments. Cervix biopsies were obtained to analyze histopathological features and to determine the local immunological changes by immunohistochemistry analyses. Placebo-treated patients showed no significant changes in the evaluated parameters. Interestingly, in DLE-treated patients, clinical manifestations of cervicitis diminished and 89% of them remitted the colposcopic lesions. Histological analyses of biopsies from DLE-treated patients showed a decreasing leukocyte infiltrate. Immunochemical analyses showed an increased expression of TGF-ß, while expression of IFN-γ, PCNA, and IL-32 decreased. Our results suggest that DLE can stimulate innate immunity of cervical mucosae, diminishing chronic cervicitis in HPV-infected patients. TRIAL REGISTRATION: Register ISRCTN16429164 Abbreviations: HPV = Human Papilloma Virus; DLE = Dialyzable leukocyte extract.

Cystic Cervicitis: A Case Report and Literature Review of Cystic Cervical Lesions.

We present a case of a 30-year-old woman who, while undergoing infertility evaluation, was found to have a large cystic cervical mass, shown to be cystic cervicitis on cervical cone biopsy. Differential diagnosis for benign cystic cervical lesions includes Nabothian cysts, tunnel cluster, endocervical hyperplasia, and cervicitis, whereas cystic cervical malignancies include adenocarcinoma and adenoma malignum. While it is crucial to differentiate benign from malignant lesions, imaging characteristics often overlap and may not provide a specific diagnosis. In difficult cases, definitive diagnosis should be based on clinical presentation and cervical biopsy.

Chronic Cervicitis: Presenting Features and Response to Therapy.

OBJECTIVES: Chronic nongonococcal nonchlamydial cervicitis is a condition of unknown etiology. Data about treatment options are limited. Our goal was to review a single center's experience in managing women with chronic NGNCC. METHODS: We evaluated all encounters at a tertiary care center with ICD-9 code for cervicitis between April 2008 and March 2014. Cases were defined by having two of the following 3 diagnostic criteria: mucopurulent discharge noted by (1) patient or (2) practitioner, and (3) cervical bleeding upon gentle probing. All women had negative nucleic acid amplification testing for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis. Information regarding patient demographics, symptoms, findings, treatment, and outcomes were analyzed. Cure was defined as resolution of patient-specific diagnostic criteria. RESULTS: Sixty-one women were identified. The mean age was 31 years; 73.7% were white, and 59% were nulliparous. The mean duration of symptoms was 25.2 months. Initially, all 61 patients received one of 3 antibiotic treatments. The cure rate after initial antibiotic treatment was 65.6%. Nineteen patients required at least one further treatment. Additional treatments included secondary antibiotics, hormonal treatments, vaginal hydrocortisone, silver nitrate, cryotherapy, and loop excision electrosurgical procedure. Cure rates were as follows: 57.9% with antibiotics, 50% with hormone treatment, 0% with hydrocortisone, 100% with silver nitrate, 0% with cryotherapy, and 100% with loop electrosurgical excisional procedure. Of the initial 61 women, 93.4% were eventually cured. CONCLUSIONS: Nongonococcal nonchlamydial cervicitis is a condition that can cause unremitting symptoms. Most patients will respond to antibiotics, although other treatments including surgery may be necessary.