Frequency of cervical intraepithelial neoplasia and infectious agents for vaginitis in menstrual cycle phase

Objective: The study objective was to verify differences in the diagnosis of infectious agents and CIN in cytological smears in the proliferative and secretory phases of the menstrual cycle.

Methods: A retrospective study was carried out at the Federal University of "Triângulo Mineiro". Presence of Candida albicans, Trichomonas vaginalis, clue cells, Doderlein bacilli, cytolytic flora, coccoid bacillus, CIN and HPV were collected from the vaginal cytology tests, cervical and endocervical in healthy women of reproductive age from 1994 to 2004 (about 14,000 in total). The cytologies were divided into two groups: proliferative and secretory phase. Chi-square and Fisher's exact tests were used for statistical analysis with the significance level set at less than 0.05.

Results: The frequency of cytolysis and candidiasis was higher in the secretory phase of the menstrual cycle (p < 0.0001). When the presence of CIN associated with vulvovaginitis was evaluated, there was no significant difference in cytologies with CIN between the first and the second phases of the menstrual cycle.

Conclusion: Frequency of the cytolytic flora and Candida albicans is influenced by the phase of the menstrual cycle, but CIN is not.

Vaginitis; Lactobacillus; Candida; Bacterial vaginosis; Papanicolaou smear; CIN

[1] Falten A., Barreau C., Bizet C. et al.: "Lactobacillus species identification, H202 production, and antibiotic resistance and correlation with human clinical status". J. Clin. Microbiol.,1 999,3 7,7 29.

[2] Gupta K., Stapleton A.E., Hooton T.M. et al.: "Inverse association of H202- producing lactobacilli and vaginal Escherichia coli colonization in women with recurrent urinary tract infections". J. infect. Dis., 1998, 178,446.

[3] Hillier S.L., Krohn M.A., Klebanoff S.J., Eschenbach DA.: "The relationship of hydrogen peroxide-producing lactobacilli to bacterial vaginosis and genital microflora of pregnant women". Obstet. Gynecol., 1992, 79, 369.

[4] Onderdonk A.B., Lee M.L., Lierbeman E. et al.: "Quantitative microbiologic models for preterm delivery". J. Clin. Microbiol., 2003, 41, 1073.

[5] Al Mushrif S., Jones B.M.: "A study of the prevalence of hydrogen peroxide generating Lactobacilli in bacterial vaginosis: the determination of H202 concentrations generated, in vitro, by isolated strains and the levels found in vaginal secretions of women with and without infection". J. Obstet. Gynecol., 1998, 18, 63.

[6] Landers D.V.,W iesenfeld H.C.,H eine R.P. et al.: "Predictive value of the clinical diagnosis of lower genital tract infection in women". Am. J. Obstet. Gynecol., 2002, 190, 1004.

[7] Agrawal B.M., Agrawal S., Rizvi G., Ansari K.H.: "Role of nonH202 producing lactobacilli and anaerobes in normal and compliocated pregnancy". J. Indian Med. Assoc., 2002, 100, 652.

[8] Karaca M., Bayram A., Kocoglu M.E. et al.: "Comparison of climcal diagnosis and microbiological test results in vaginal infections". Clin. Exp. Obstet. Gynecol., 2005, 32, 172.

[9] Murta E.F.C., Souza M.A., Araujo Junior E., Adad S.J.: "Incidence of Gardnerella vaginalis, Candida sp and human papilloma virus in cytological smears". Sao Paulo Med. J., 2000, 118, 105.

[10] Adad S.J., Lima V.R., Sawan Z.T.E. et al.: "Frequency of Trichomonas vaginalis, Candida sp, and Gardnerella vaginalis in cervical-vaginal smears in four different decades". Silo Paulo Med. J., 2001, 119, 200.

[11] Garcia-Closas M., Herrero R., Bratti C. et al.: "Epidemiologic determinants of vaginal pH". Am. J. Obstet. Gynecol., 1999, 180, 1060.

[12] Konje J.C., Otolorin E.O., Ogunniyi J.0. et al.: "The prevalence of Gardnerella vaginalis, Trichomonas vaginalis and Candida albicans in the cytology clinic at Ibadan, Nigeria". Afr. J. Med. Sci., 1991, 20, 29.

[13] Mirza N.B., Nsanze H., D'Costa L.J., Piot P.: "Microbiology of vaginal discharge in Nairobi, Kenya". Br. J. Vene. Dis., 1983, 59, 186.

[14] Oyarzun E.E., Poblete A.L., Montiel F.A., Gutierrez P.H.: "Yaginosis bacteriana: diagnostico y prevalencia". Rev. Chil. Obstet. Ginecol., 1996, 61, 28.

[15] Ray A., Gulati A.K., Pandey L.K., Pandey S.: "Prevalence of common infective agents of vaginitis". J. Commun. Dis., 1989, 21, 241.

[16] Rivera L.R., Trenado M.Q., Valdez A.C., Gonzalez C.J.C.: "Prevalencia de vaginitis y vaginosis bacteriana: associaci6n com manifestaciones clfnicas de laborat6rio y tratamiento". Ginec. y Obstet. Mex., 1996, 64, 26.

[17] Murta E.F.C., Filho A.C.A., Barcelos A.C.M.: "Relation between vaginal and endocervical pH in pre and post-menopausal women". Arch. Gynecol. Obstet., 2005, 272, 211.

[18] Amsel R., Totten P.A., Spiegel C.A. et al.: "Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiological associations". Am. J. Med., 1983, 74, 14.

[19] Spiegel C.A.: "Bacterial vaginosis". Clin. Microbiol. Rev., 1991, 4,485.

[20] Josey W.E., Lambe D.W. Jr.: "Epidemiologic characteristics of women infected with Corynebacterium vaginale (Haemophilus vaginalis)". J. Am. Vener. Dis. Assoc., 1976, 3, 9.

[21] Platz-Christensen J.J., Sundstrom E., Larsson P.G.: "Bacterial vaginosis and cervical intraepithelial neoplasia". Acta Obstet. Gynecol. Scand., 1994, 73, 586.

[22] Herrero R., Brinton L.A., Reeves W.C. et al.: "Behavior, venereal diseases, hygiene practices, and invasive cervical cancer in a highrisk population". Cancer, 1990, 65, 380.

[23] Koutsky L.A.: "A case-control study of precancer of the uterine cervix in a high risk population [dissertation]". Seattle (WA): University of Washington, 1987.

[24] Schmauz R.,O kong P.,V illiers E.M. et al.: "Multiple infections in cases of cervical cancer from high-incidence area in tropical Africa". Int. J. Cancer, 1989, 43, 805.

[25] Boyle D.C., Barton S.E, Uthayakumar S. et al.: "Is bacterial vag1- nosis associated with cervical intraepithelial neoplasia?". Int. J. Gynecol. Cancer, 2003, 13, 159.

[26] Harington J.S.: "Epidemiology and aetiology of cancer of the uterine cervix including the detection of carcinogenic Nnitrosamines in the human vaginal vault". S. Afr. Med. J.,1 975,4 9, 443.

[27] Jones B.M., al-Fattani M., Gooch H.: "The determination of amines in the vaginal secretions of women in health and disease". Int. J. STD AIDS, 1994, 5, 52.

[28] Sobel J.D.: "Vaginal infections in adult women". Sex. Transm. Dis., 1990, 74, 1573.

[29] Sobel J.D., Faro S., Force R. et al.: "Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations". Am. J. Obstet. Gynecol., 1998, 178, 203.

[30] Kalo-Klein A., Witkin S.S.: "Candida albicans: cellular immune system interactions during different stages of the menstrual cycle". Am. J. Obstet. Gynecol., 1989, 161, 1132.

[31] Murta E.F., Silva A.O., Silva E.A., Adad S.J.: " Frequency of infectious agents for vaginitis in non- and hysterectomized women". Arch. Gynecol. Obstet., 2005, 273, 152.

[32] Gupta P.K.: "Microbiology, inflammation, and viral infections". In: Bibbo M. (ed.). Comprehensive Cytopathology. Philadelphia, WB Saunders, 1997, 125.

[33] Solomon D.: "The Bethesda system for cervicovaginal cytopathology". In: Bibbo M. (ed.). Comprehensive Cytopathology. Philadelphia: WB Saunders, 1997, 93.

[34] Wied G.L., Bibbo M.: "Hormonal Cytology". In: Bibbo M. (ed.). Comprehensive Cytopathology. Philadelphia: WB Saunders , 1997, 101.

[35] Aroutcheva A., Gariti D., Simon M. et al.: "Defense factors of vaginal lactobacilli". Am. J. Obstet. Gynecol., 2001, 185, 375.

[36] Cibley L.J.: "Cytolytic vaginosis". Am. J. Obstet. Gynecol., 1991, 165, 1245.

[37] Redondo-Lopez V.,C ook R.L., Sobel J.D.: "Emerging role of Lactobacilli in the control and maintenance of the vaginal bacterial microflora". Rev. Infect. Dis., 1990, 12, 856.

[38] Caillouette J.C., Sharp C.F., Zimmerman G.J., Roy S.: "Vaginal pH as a marker for bacterial pathogens and menopausal status". Am. J. Obstet. Gynecol., 1997, 176, 1270.

[39] Silva C.S., Adad S.J., Souza M.A.H. et al.: "Increased frequency of bacterial vaginosis and chlamydia trachomatis in pregnant women with human Papillomavirus infection". Gynecol. Obstet. Invest., 2004, 58, 189.

[40] F idel P.L., Cutright J., Steele C.: "Effects of reproductive hormones on experimental vaginal candidiasis". Infect. lnnun., 2000, 68, 651.

[41] Peters N., Van Leewen AM., Pieters W.J. et al.: "Bacterial vaginosis is not important in the etiology of cervical neoplasia: A survey on women with dyskaryotic smears". Sex. Transm. Dis., 1955, 22, 296.

[42] Eschenbach D.A., Davick P.R., Williams B.L. et al.: "Prevalence of hydrogen peroxide-producing Lactobacillus species in normal women and women with bacterial vaginosis". J. Clin. Microbial., 1989, 27, 251.

[43] Morison L., Ekpo G., West B. et al.: "Bacterial vaginosis in relation to menstrual cycle, menstrual protection method, and sexual intercourse in rural Gambian women". Sex. Transm. Infect., 2005, 81,242.

[44] Harper D.M., Longacre M.R., Noll W.W. et al.: " Factors affecting the detection rate of human papillomavirus". Ann. Fam. Med., 2003, I, 221.

[45] Guijon F., Paraskevas M., Rand F. et al.: "Vaginal microbial flora as a cofactor in the pathogenesis of uterine cervical intraepithelial neoplasia". Int. J. Gynaecol. Obstet., 1992, 37, 185.

[46] Peters N., Van Leeuwen A.M., Pieters W.J. et al.: "Bacterial vaginosis is not important in the etiology of cervical neoplasia: a survey on women with dyskaryotic smears". Sex. Transm. Dis., 1995, 22, 296.

[47] Frega A.,S tentella P., Spera G. et al.: "Cervical intraepithelial neoplasia and bacterial vaginosis: correlation or risk factor?". Eur. J. Gynaecol. Oneal., 1997, 18, 76.