Association between Trichomonas vaginalis infection and cervical lesions: a population-based, nested case-control study in Taiwan.

Trichomonas vaginalis is the most common nonviral sexually transmitted infection. According to the 2019 WHO cancer report, cervical cancer is the fourth most frequent cancer in women. However, previous research, which has not included a large-scale study to date, has revealed that Trichomonas vaginalis increases cervical cancer risk. In this study, we investigated a group of Asian females in Taiwan to determine the association between trichomoniasis and the risk of developing cervical lesions, including cancer, neoplasm, and dysplasia. We conducted a nested case-control study by using the National Health Insurance (NHI) program database in Taiwan. The International Classification of Diseases, 9th Revision classifications (ICD-9-CM) was used to categorize all of the medical conditions for each patient in the case and control groups. The adjusted odds ratio (AOR) and 95% confidence interval (CI) for the association between trichomoniasis and cervical lesions were estimated using multivariable conditional logistic regression to adjust for all comorbidities and variables. In total, 54,003 individuals were enrolled in the case group and 216,012 were enrolled in the control group. Trichomonas vaginalis exposure had a significant association with cervical lesions (AOR 2.656, 95% CI = 1.411-5.353, p = 0.003), especially cervical cancer (AOR 3.684, 95% CI = 1.622-6.094, p = 0.001). In patients with both trichomoniasis and depression, the relative risk increased 7.480-fold compared to those without trichomoniasis or depression. In conclusion, female patients with Trichomonas vaginalis exposure had a significantly higher risk of developing cervical lesions (especially cervical cancer) than those without exposure.

Cervical strongyloidiasis in an immunocompetent patient: A clinical surprise.

A 32-year-old lady came for a routine gynecological check up. Her cervical cytologic smear was reported as low grade squamous intraepithelial lesion. As a part of basic routine investigation, cervical punch biopsy was done. Astonishingly it revealed multiple rhabditiform larvae of Strongyloides stercoralis. These were curved thick with pointed end and a short buccal cavity. She did not have any history of immunosuppression including steroid therapy and was otherwise normal. Extensive review of the literature on parasites encountered in cervix yielded few case reports on strongyloides in cytologic smears, but failed to reveal any report till date on S. stercoralis found in histopathology section. Our case is probably the first in the world and the first reported from India to the best of our knowledge. We describe this case of strongyloidiasis of cervix with review of the literature on various parasites encountered in the cervix because of its rarity and also to keep this parasitic infestation as a differential diagnosis of cervical lesions.

[Endocervical schistosomiasis: case report]. / Esquistossomose endocervical: relato de caso.

Schistosomiasis mansoni is found in different endemic areas of Brazil. It is a serious public health problem in Brazil and worldwide. Ectopic forms of the disease may affect the female reproductive system, representing a rare type of Schistosoma mansoni infection. A 26-year-old patient complained of vaginal discharge, dyspareunia and pain on palpation of the hypogastrium. Gynecological examination revealed an endocervical polyp. A biopsy was performed. Under microscopy, several granulomas surrounding degenerate and viable eggs of Schistosoma mansoni were seen. Treated with praziquantel, she was asymptomatic after four weeks of treatment. Vaginal discharge and dyspareunia may be secondary causes of cervicitis caused by Schistosoma mansoni. The search for eggs in routine vaginal smear or histological examination should be part of the gynecologic evaluation of patients from endemic areas, with the purpose of tracking ectopic schistosomiasis of the female genital tract.

Whole Slide Imaging of Pap Cell Block Preparations versus Liquid-Based Thin-Layer Cervical Cytology: A Comparative Study Evaluating the Detection of Organisms and Nonneoplastic Findings.

OBJECTIVE: Cervical cancer is one of the most common malignancies worldwide, yet it is preventable by population screening. In a previous study, we confirmed the feasibility of utilizing whole slide imaging (WSI) of cell block (CB) preparations to overcome the limitations of digitizing cytologic samples. In this study, we evaluated the accuracy of WSI in identifying various organisms and nonneoplastic findings. STUDY DESIGN: A total of 335 WS images from Pap CB preparations were analyzed using the Aperio system. The test performance characteristics of ThinPrep (TP) and WSI samples were compared for adequacy, for the presence of bacterial vaginosis (BV), fungi, Trichomonas vaginalis (TV) and herpes simplex virus (HSV) and for nonneoplastic findings. RESULTS: The WSI samples contained optimal material from all preparations. BV was diagnosed in 33 WSI versus 36 TP samples. Budding yeasts and/or pseudohyphal forms were noted in 18 WSI versus 19 TP samples. TV organisms (10 of 11 samples) and 1 HSV case were accurately identified in the WSI and TP samples. Squamous metaplasia, keratosis and reactive/reparative and inflammatory changes were easily identified by WSI. CONCLUSIONS: The concept of WSI from Pap CB preparations is potentially feasible for adoption. Digital remote web-based technology eliminates the need for an individual on site, saving time and resources.

Esquistossomose endocervical: relato de caso / Endocervical schistosomiasis: case report

A esquistossomose mansoni, endemia encontrada em diferentes áreas do território brasileiro, constitui um grave problema de saúde pública no Brasil e no mundo. Formas ectópicas da doença podem acometer o sistema reprodutor feminino, constituindo um tipo raro de infecção pelo S. mansoni. Paciente com 26 anos queixava-se de corrimento vaginal, dispareunia e dor à palpação do hipogástrio. No exame ginecológico foi observado pólipo endocervical, que foi biopsiado. O exame histológico evidenciou vários granulomas envolvendo ovos degenerados e viáveis de Schistosoma mansoni. Tratada com praziquantel, retornou assintomática após quatro semanas do tratamento. Corrimento vaginal e dispareunia podem ser causas secundárias de cervicite por Schistosoma mansoni. Pesquisa de ovos em esfregaço vaginal de rotina ou exame histológico devem fazer parte da avaliação ginecológica de pacientes de área endêmica, com o objetivo de rastrear forma ectópica da esquistossomose do trato genital feminino.

Schistosomiasis mansoni is found in different endemic areas of Brazil. It is a serious public health problem in Brazil and worldwide. Ectopic forms of the disease may affect the female reproductive system, representing a rare type of Schistosoma mansoni infection. A 26-year-old patient complained of vaginal discharge, dyspareunia and pain on palpation of the hypogastrium. Gynecological examination revealed an endocervical polyp. A biopsy was performed. Under microscopy, several granulomas surrounding degenerate and viable eggs of Schistosoma mansoni were seen. Treated with praziquantel, she was asymptomatic after four weeks of treatment. Vaginal discharge and dyspareunia may be secondary causes of cervicitis caused by Schistosoma mansoni. The search for eggs in routine vaginal smear or histological examination should be part of the gynecologic evaluation of patients from endemic areas, with the purpose of tracking ectopic schistosomiasis of the female genital tract.

Isolated hydatid cyst of uterine cervix: A case report.

Hydatid disease is an endemic infection which can affect any organ, mainly the liver and lungs. Peritoneal echinococcosis is usually known to occur secondary to hepatic hydatid cyst rupture into the peritoneal cavity. An isolated cyst in the pelvic cavity is considered as primary only when there are no other hydatid cysts. Herein, we report an isolated pelvic-cervical hydatid cyst which presented without any involvement of the other abdominal organs or lungs. Our patient, a 27-year-old woman with the primary complaints of dyspareunia and chronic pelvic pain, had thin-walled large cystic mass originating from the cervix, diagnosed by ultrasonography. She underwent surgery with the most likely initial diagnosis of exophytic fibroid with cystic degeneration. Gynecologists should be aware of the possibility of isolated primary hydatid cyst of the pelvic cavity and should consider this condition in the differential diagnosis of cystic pelvic masses, especially in areas where the disease is endemic.

Schistosomiasis: an unusual finding of the cervix.

BACKGROUND: Schistosomiasis remains a major threat to women's health in many resource-poor countries and is being seen with increasing frequency in developed countries among immigrants and tourists who have a history of freshwater exposure in endemic areas. CASE: A 28-year-old asymptomatic African immigrant presented with an abnormal Pap test result showing rare atypical squamous cells. Colposcopy examination showed pale-yellow, finely granular cervical lesions. Calcified Schistosoma hematobium eggs were identified by histology but were absent in urine and stool specimens. Praziquantel treatment was initiated promptly, avoiding significant morbidity. CONCLUSION: The differential diagnosis of female genital schistosomiasis should be considered for patients who have a history of residence in or travel to endemic areas, including asymptomatic patients and patients presenting a long time after exposure.

[Mansonelliasis identified by a cervicovaginal smear at the university hospital center of Bobo-Dioulasso (Burkina Faso)]. / Frottis cervicovaginal révélant une mansonellose au centre hospitalier universitaire de Bobo-Dioulasso, Burkina Faso

INTRODUCTION: Mansonella perstans is a genus of filaria that is often asymptomatic or responsible for unspecific symptoms. M. perstans microfilariae are uncommon on cervicovaginal smears. CASE: We report the case of a woman with pruritis and eosinophilia. Microfilariae of M. perstans were observed on both cervicovaginal and blood smears. The patient was successfully treated with a combined single dose of 400 mg of albendazole and ivermectin (150 µg/kg). CONCLUSION: We described here an atypical and rare localization of M. perstans. The routine examination of cervicovaginal smears of women admitted to Bobo-Dioulasso Hospital for screening of cervical neoplasia should allow us to determine the frequency of this parasitosis and propose appropriate treatment.

Development of a pigtail macaque model of sexually transmitted infection/HIV coinfection using Chlamydia trachomatis, Trichomonas vaginalis, and SHIV(SF162P3).

BACKGROUND: Sexually transmitted infections (STIs) are associated with an increased risk of HIV infection. To model the interaction between STIs and HIV infection, we evaluated the capacity of the pigtail macaque model to sustain triple infection with Trichomonas vaginalis, Chlamydia trachomatis, and SHIV(SF162P3). METHODS: Seven SHIV(SF162P3) -infected pigtail macaques were inoculated with T. vaginalis only (n = 2), C. trachomatis only (n = 1), both T. vaginalis and C. trachomatis (n = 2), or control media (no STI; n = 2). Infections were confirmed by culture and/or nucleic acid testing. Genital mucosa was visualized by colposcopy. RESULTS: Characteristic gynecologic signs were observed for both STIs, but not in control animals. Manifestations were most prominent at days 7-10 post-infection. STIs persisted between 4 and 6 weeks and were cleared with antibiotics. CONCLUSIONS: These pilot studies demonstrate the first successful STI-SHIV triple infection of pigtail macaques, with clinical presentation of genital STI symptoms similar to those observed in humans.

The prevalence of sexually transmitted and other lower reproductive tract infections among rural women in Sichuan Province, China.

To estimate the prevalence of sexually transmitted infections (STI) and lower reproductive tract infections (RTI) and determine risk factors for STI among rural women in Sichuan Province, China, a cross-sectional, community-based cluster sample of 2,000 rural, married women were interviewed, examined and clinical specimens collected to assess for six STI and two non-sexually transmitted RTI. The overall prevalence of any STI was 10.9% (95% CI 9.5-12.3); of any STI or RTI was 30.8% (95% CI 28.7-32.8). Chlamydia trachomatis was detected in 6.4% of women, Neisseria gonorrhoeae in 1.7%, Treponema pallidum in 0.5%, human papilloma virus in 0.6%, herpes simplex virus type-2 in 2.0%, Candida albicans in 8.8%, Trichomonas vaginalis in 0.7% and bacterial vaginosis in 15.4%. The reported low risk sexual behavior was corroborated by the prevalence of STIbased on laboratory findings. The prevalence of Chlamydia trachomatis alone and the combined prevalence rates of Neisseria gonorrhoeae and Chlamydia trachomatis were high enough (7.9%) to consider interventions for the control of cervical infections. Health promotion messages regarding safe sexual and health care seeking behavior is important. Routine STI surveillance, including prevalence studies, which provide accurate information for decision-making should be continued as an essential component of good STI control.

Myiasis in the uterine cavity of an elderly woman with a complete uterine prolapse.

Myiasis is the infestation of the tissues of vertebrate animals by the larvae of flies (maggots). As the condition generally occurs in exposed areas of the body, genital myiasis is a rare condition, and myiasis of the uterine cavity is even rarer, only one case having been previously described in the literature. The case reported here describes myiasis of the uterine cavity and ulcerated vaginal mucosa of an 89-year-old woman with a severe (third-degree) genital prolapse. This case describes an extremely rare situation, and emphasizes the need for good hygiene and surgical correction in patients with a genital prolapse.

Significance of a diagnosis of microorganisms on pap smear.

The Pap smear has been in use for more than half a century as the primary screening test for preinvasive and invasive lesions of the uterine cervix. Although not the primary use and an imperfect test, it can be extremely useful in the diagnosis of some microorganisms. This review focuses on the use of the Pap smear in the diagnosis of several microorganisms including Actinomyces, Chlamydia trachomatis, Candida, Trichomonas vaginalis, Leptothrix vaginalis, Herpes Simplex Virus, the causative agents of bacterial vaginosis, and other rarer organisms. The accuracy of diagnosis using the smear varies among the different organisms in question.