Uterine cervical ectopy during reproductive age: cytological and microbiological findings.

Cervical ectopy is common in adolescents, pregnant women, and those taking high doses of estrogen-containing contraceptives. The majority of cases have spontaneous reversion, but some cases can be persistent. Studies suggested that the adequacy of a Pap smear could be affected and there is an increased risk cervical infections. This study is a cross-sectional study conducted from December 2009 to February 2011 with 457 women with cervical ectopy and 736 without ectopy. Cervical samples were collected in vials for analysis by ThinPrep cytology (Hologic, Marlborough, MA). The Mann-Whitney test and Fisher's exact test (95% CI) were applied. The study was approved by the ethics committee of the Federal University of Ceará. The mean ages of the study group and control group were 28.7 (±14.8) and 33.6 (±7.5) years old, respectively (P < 0.0001). Negative diagnosis for malignancy and intraepithelial lesion was present in 399 (87%) cases and 705 (96%) in the study and control groups, respectively (P < 0.0001). Shift in the flora suggestive of bacterial vaginosis (BV) was observed more frequently in the study group: 74 (16.2%) than in the control group: 86(11.7%) (P = 0.017). The differences among the other morphotypes showed no significance. The smears were atypical in 12.7% (58/457) of the patients from the study group and in 4.2% (31/736) in the control group (P < 0.001; RR = 3 [2.033-4.712]). The association between ectopy and inflammatory cytology, the presence of the shift in the flora suggestive of BV and cytological atypia is evident.

Evidence for benefits from treating cervical ectopy: literature review.

CONTEXT AND PURPOSE: Uterine cervical ectopy (cervical erosion) is today considered to be a physiological condition, but there still seems to be a strong tendency towards treating it. The purpose of this study was to review the medical literature for evidence regarding benefits from treating cervical ectopy. METHODS: The following databases were reviewed: Medical Literature Analysis and Retrieval System Online (Medline), Excerpta Medica Database (Embase), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and Cochrane Library databases. In addition, six medical textbooks were consulted. RESULTS: The review showed that: 1) there is probably an association between ectopy and higher risk of Chlamydia trachomatis, human papillomavirus and human immunodeficiency virus infection; 4) there is probably an association between ectopy and cervical intraepithelial neoplasia; 5) there is an association between ectopy and mucous discharge and nocturia; and 6) there is no evidence of an association between ectopy and cervical cancer, or of protection against cervical cancer associated with ectopy treatment. CONCLUSIONS: 1) No data were found in the medical literature to support routine treatment for ectopy; 2) Treatment could be recommended for symptom relief, but more symptoms are attributed to ectopy than could be demonstrated in a controlled study; 3) Further studies to test the hypothesis of protection against cervical cancer associated with treatment are necessary.

Evidence for benefits from treating cervical ectopy: literature review / Evidências de benefícios no tratamento de ectopia do colo do útero: revisão de literatura

CONTEXT AND PURPOSE: Uterine cervical ectopy (cervical erosion) is today considered to be a physiological condition, but there still seems to be a strong tendency towards treating it. The purpose of this study was to review the medical literature for evidence regarding benefits from treating cervical ectopy. METHODS: The following databases were reviewed: Medical Literature Analysis and Retrieval System Online (Medline), Excerpta Medica Database (Embase), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and Cochrane Library databases. In addition, six medical textbooks were consulted. RESULTS: The review showed that: 1) there is probably an association between ectopy and higher risk of Chlamydia trachomatis, human papillomavirus and human immunodeficiency virus infection; 4) there is probably an association between ectopy and cervical intraepithelial neoplasia; 5) there is an association between ectopy and mucous discharge and nocturia; and 6) there is no evidence of an association between ectopy and cervical cancer, or of protection against cervical cancer associated with ectopy treatment. CONCLUSIONS: 1) No data were found in the medical literature to support routine treatment for ectopy; 2) Treatment could be recommended for symptom relief, but more symptoms are attributed to ectopy than could be demonstrated in a controlled study; 3) Further studies to test the hypothesis of protection against cervical cancer associated with treatment are necessary.

CONTEXTO E OBJETIVO: A ectopia do colo do útero é hoje considerada um fenômeno fisiológico, mas parece ainda haver uma forte tendência no sentido da intervenção (tratamento). Este estudo se propõe a realizar revisão da literatura buscando evidências de benefícios conseqüentes ao tratamento da ectopia. MÉTODOS: Pesquisa nas bases Medical Literature Analysis and Retrieval Sysem Online (Medline), Excerpta Medica Database (Embase), Literatura Latino-Americane e do Caribe em Ciências da Saúde (Lilacs), Biblioteca Cochrane e seis livros especializados. RESULTADOS: A revisão mostrou que: 1) existe provavelmente associação de ectopia com infecção cervical por Chlamydia trachomatis, pelo vírus HPV e maior risco de soroconversão para HIV; 2) existe provavelmente associação entre ectopia e neoplasia intra-epitelial cervical; 3) existe associação com mucorréia e nictúria; 4) não existem evidências sobre associação entre ectopia e câncer de colo do útero nem sobre proteção contra este câncer proporcionada pelo tratamento da ectopia. CONCLUSÕES: 1) Não foram encontrados na literatura dados que justifiquem o tratamento rotineiro da ectopia; 2) O tratamento pode ser utilizado para tratar sintomas associados à ectopia, porém mais sintomas são atribuídos à ectopia do que se pôde confirmar em um estudo controlado; 3) Seriam necessários novos estudos para testar a hipótese de proteção contra o câncer de colo proporcionada pelo tratamento.

[Detection of human papillomavirus in cervical tissues using polymerase chain reaction].

Detection of human papillomavirus (HPV) 16 and 18 infection by polymerase chain reaction (PCR) was carried out in patients with normal cervix 53 cases, Chronic cervicitis with cervical erosion 59 cases, cervical cancer 12 cases, atypical hyperplasia 3 cases and condyloma acuminatum 2 cases. Results showed that a significantly higher detective rate of HPV-16 and 18 DNA in cervical cancer than in normal cervix, and a higher but not statistically significant positive rate than that in cervical erosion. It indicates that some cases of chronic cervicitis with HPV infection might develop into cervical carcinoma. This finding may help in the early discovery and prevention of cervical cancer.

[Infections caused by viruses and Chlamydia trachomatis on uterine cervix].

A study on the infections caused by HPV-16, HSV-2, CMV and Chlamydia trachomatis (CT) on the uterine cervices were carried out among 188 normal cases and 544 patients with chronic cervicitis using ELISA, virus isolation and/or DNA hybridization methods. The detection rates of these four pathogens in erosive cervices were 23.9% (64/268), 26.5% (99/374), 14.0% (22/157) and 13.4% (18/134), respectively, which were significantly higher than that in normal cervices. The total detection rate of four pathogens was 48.5% in erosive cervices, 26.8% in normal cervices at fertile age and 44.1% in normal cervices during the menopausal period. Obtained results indicate a high incidence of sexually transmitted diseases in women in Beijing area. Based on above mentioned results and our experience, a simple procedure for the detection of HPV, HSV, CMV and CT on the uterine cervices was suggested.

[Detection of Chlamydia trachomatis infection of the cervical canal in women with infertility and cervical erosion]. / Wykrywanie zakazen Chlamydia trachomatis w kanale szyjki macicy u kobiet z nieplodnoscia i nadzerka szyjki macicy.

Using the immunoenzymatic test "Pharmacia Chlamydia EIA" the incidence of Chlamydia trachomatis infection of the cervical canal was studied in 141 women from groups of higher risk for this infection. C. trachomatic was found in 5% of women with infertility and 6.2% of women with non-treated cervical erosion.

Oncornavirus-like particles in biopsy material from a glandular erosion of the human uterine cervix.

Virus-like particles have been detected electron microscopically in biopsy material from a glandular erosion of the human uterine cervix. Morphologically, the particles resemble immature and mature type C virus particles. The significance of the oncornavirus-like structures remains unknown.

Isolation of Chlamydia from women attending a clinic for sexually transmitted disease.

Cervical swabs for Chlamydia culture were collected from 638 unselected women attending a sexually transmitted diseases clinic with a fresh complaint. Chlamydia were isolated from 76 (12 per cent.) of the women. When the results were related to the patients' diagnoses, Chlamydia were present in 44 per cent. of women with gonorrhoea and in 22 per cent. of women who were contacts of men with nonspecific urethritis (women who may be regarded as having non-specific genital infection). Chlamydia were uncommon in women with no evidence of genital infection. Significant correlations were found between the presence of Chlamydia and cervical erosion, cervical cytological inflammatory change, and absence of symptoms. Isolates were obtained more frequently from women with non-specific genital infection who were primary contacts than from women who were secondary contacts. These findings support the concept that Chlamydia are pathogens in the genital tract and are sexually transmitted.

Simplified method for diagnosis of genital and ocular infections with Chlamydia.

The diagnosis of infections with chlamydia related to the trachoma agent is best confirmed by isolation of the organism in tissue-culture. A simplified technique using conventional monolayers of McCoy cells can be used as an alternative to current methods involving heavily irradiated cells and appears to be of reasonable sensitivity. Chlamydial infection was confirmed in 38/190 females attending venereal clinics, in 22/35 patients with hypertrophic cervical erosions, and in 7/18 infants with ophthalmia neonatorum.