Prevalence of Chlamydia trachomatis in human immunodeficiency virus-infected women in Cuba

To determine the prevalence rates and serovar distribution of Chlamydia trachomatis cervical infections in Cuban women, two different groups were selected. Group I consisted of 60 human immunodeficiency virus (HIV-1) seropositive women from different regions of Cuba and group II of 60 randomly selected women HIV seronegative and apparently healthy. C. trachomatis was detected in cervical scrapes by mean of nested polymerase chain reaction (PCR) specific for major out membrane protein. The overall prevalence rate of C. trachomatis in cervical scrapes determined by nested PCR was 10% in group I and the estimated prevalence was 6.6% for group II; 83.3% of HIV seropositive women with C. trachomatis infection reported history of pelvic inflammatory disease followed by cervicitis (50%). The control group C. trachomatis-infected women referred a history of cervicitis in 75% of cases. Other reports in the latter group included infertility and pelvic inflamatory disease in 50%. The present study is the first report of C. trachomatis prevalence in Cuba. It showed that there was not significantly difference in the prevalence rate of C. trachomatis between both groups.     

Chlamydia trachomatis infection and human papillomavirus in women with cervical neoplasia in Pernambuco-Brazil

Chlamydia trachomatis (CT) is the most common bacterial cause of sexually transmitted disease. High-risk human papillomavirus (HR-HPV) is considered the main etiological agent for cervical neoplasia. Evidences showed that the presence of co-infection of CT and HR-HPV plays a central role in the etiology of cervical intraepithelial neoplasia (CIN) and cervical cancer. The goals of this study were: evaluate the human papillomavirus (HPV) and CT prevalence among Brazilian women with abnormal cytology and provide the effect of this association on the severity of cervical neoplasia. The population of this study was composed by 142 women with incident histological incidence of CIN grades I, II, III or cervical cancer from Recife, Northeast of Brazil. The polymerase chain reaction method on a cervical brush specimen was used to detect both agents and the automatic sequencing method was used for HPV genotyping assay. The prevalence of HPV and CT was 100 and 24.65 %, respectively. Thirteen types of HPV were detected; HPV 16, 18, 31 and 33 were the most common. The most prevalent HPV types were HPV 16 and 18. A significant association between CT positive and HPV 16 infection was found (p < 0.0106; OR = 5.31; 95 % IC 1.59–17.67). In the study population, there was diversity of HPV infections, with high-risk types being the most common. Also, the data collected suggest that CT infection may play an important role in the natural history of HPV infection.     

Comparative cytologic features of adenocarcinoma in situ of the uterine cervix

The cytologic findings in 30 cases of adenocarcinoma in situ (AIS) and related lesions of the cervix were compared with those in 13 cases of cervical invasive adenocarcinoma and 8 cases of cervical nonneoplastic conditions that mimicked AIS cytologically. Although there was considerable overlap, the presence of large cells with irregular nuclei and uneven chromatin distribution in smears containing no normal endocervical cells helped to distinguish invasive adenocarcinoma from AIS. The presence of "feathering," rosettes, mitotic figures and very crowded nuclei with scant cytoplasm and without cilia helped distinguish AIS from benign conditions.     

DNA sequences of human papillomavirus types 11, 16, and 18 in lesions of the uterine cervix in the west of Scotland.

Punch biopsy specimens of the cervix were examined both histologically and for the presence of human papillomavirus (HPV) DNA sequences. The presence of HPV DNA sequences was sought with the Southern blot technique using radioactively labelled HPV-6, 11, 16, and 18 DNA probes, both together and separately. Twenty six biopsy specimens were examined. Histological examination showed cervical intraepithelial neoplasia grade 2 or 3 in 16 specimens, viral changes (koilocytosis) in four, and inflammation or a normal appearance in three. Eleven specimens were negative for HPV DNA sequences, 10 contained HPV-16 DNA, four contained HPV-18 DNA, and one contained both HPV-18 and HPV-11 DNA. Episomal HPV-16 DNA was detected in one case of cervical intraepithelial neoplasia grade 3 and in five cases of cervical intraepithelial neoplasia grade 2/3 with koilocytosis; and episomal HPV-18 DNA was found in two specimens classed as cervical intraepithelial neoplasia grade 2/3, one of which also contained HPV-11 DNA, and in one specimen that showed viral changes alone. Integrated HPV DNA was found in six specimens (four with HPV-16 DNA and two with HPV-18 DNA), including two cases of chronically inflamed cervix with no histological evidence of viral infection or cervical intraepithelial neoplasia. Detection of viral DNA in early lesions may identify patients at risk of malignant progression. This is the first report of HPV-18 DNA in cervical intraepithelial neoplasia in Scotland.     

Prevalence of Chlamydia trachomatis infections in Karachi, Pakistan.

An epidemiological study was carried out to determine the prevalence of Chlamydia infections in adult females by enzyme immunoassay and microscopic examination of Giemsa-stained smears. Endocervical swabs were collected from 126 females attending OB/GYN ward at Abbasi Shaheed Hospital, Karachi. 13.5% of 126 females tested were positive by enzyme immunoassay and only 5.6% were positive by the Giemsa-staining method. The infection rate among pregnant and nonpregnant women with urinogenital problems were 11.8% and 14.7%, respectively. The majority of females complained of excessive cervical discharge and pain in the lower abdomen. A high prevalence of infection in normal pregnant women (18.2%) indicates the asymptomatic nature of this infection.     

Prevalence of Chlamydia trachomatis and genital mycoplasmas in asymptomatic women.

To establish the prevalence of Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum in women attending a family planning and a prenatal clinic in Halifax, cervical swabs were obtained at the time of the first visit from 491 women who had no symptoms of genital infection. Among the women attending the family planning clinic M. hominis occurred in combination with C. trachomatis more frequently than expected (p less than 0.05). It occurred in the absence of U. urealyticum in only a few cases (13% of the occurrences in the family planning clinic and 6% of those in the prenatal clinic). C. trachomatis was significantly more prevalent in women under 25 years of age (p less than 0.04). However, mycoplasmas were as prevalent in women over 30 years as in those under 30. There were no significant differences in the infection rates of the organisms by trimester among pregnant women. More research is necessary for a proper understanding of the role of M. hominis and U. urealyticum in genitourinary infections and pregnancy outcomes.     

Comparison of suspicious and positive colposcopic, cytologic and histologic findings in the uterine cervix

One hundred thirty-five cases of suspicious or positive colposcopic or cytologic findings were histologically analyzed. In cases of colposcopically detectable atypical changes or suspicious findings as well as of cytologic dysplasias or carcinomas, the histologic diagnoses were almost the same. The results demonstrated that colposcopy and cytology with a quick staining method are of value. Biopsy can quickly follow in cases of suspicious findings.     

Reproducibility of the cytologic diagnosis of human papillomavirus infection

As part of a larger epidemiologic investigation of the association between human papillomavirus (HPV) infection and cervical intraepithelial neoplasia, the reliability of the cytologic diagnosis of HPV infection was examined. A random sample of cervicovaginal specimens with cytologic changes characteristic of HPV infection were matched with a second set of slides, with regard to the date and severity of the smear and the age of the woman from whom the smear was obtained. The kappa statistic for interobserver agreement was 0.38 (p less than 0.0005), increasing to 0.68 (p less than 0.0005) when uncertain diagnoses were excluded. Intraobserver agreement ranged from kappa = 0.40 to 1.00. Although this agreement is within the range of reliability found for the diagnosis of other atypical cytologic changes, considerable variation is present. The effect of this variability on the validity of estimating the risk of cervical cancer associated with HPV infection may be considerable.     

Significance of cytologic smears in the diagnosis of small cell carcinoma of the uterine cervix

OBJECTIVE: To provide improved identification of small cell carcinoma (SMCC) and reevaluate the significance of cervical cytologic smears in its diagnosis. STUDY DESIGN: Analyses of histocytologic morphology and clinical data were performed by reviewing clinical records, histopathology and cervical cytology smears from 18 SMCC cases of the uterine cervix (including one recurrent case and three SMCC cases with adenocarcinoma) between 1986 and 2001. RESULTS: Most cases showed minimal cytoplasm, finely stippled ("salt and pepper") chromatin, prominent nuclear molding and smearing effect. Cytologic smears diagnosed or suggested 79% of SMCC cases before histologic confirmation. Of the cases, 89% displayed moderate to high cellularity. The tumor cells were arranged mostly in clusters of varying sizes with no typical architectural pattern. In addition, the tumors often exhibited very pleomorphic cells and recognizable nucleoli. CONCLUSION: Cytologic features of SMCC cells are characteristics enough for specific diagnosis or at least an early indication of it. Timely detection by cervical cytologic smears will allow clinicians to initiate prompt treatment of these aggressive tumors.     

AgNOR, p16 and human papillomavirus in low-grade squamous intra-epithelial lesions of the uterine cervix. Preliminary report

It has been shown that infection with high-risk human papillomaviruses (HR-HPV) is related to the development of cervical cancer. The persistence of the virus in intra-epithelial lesions of cervix uteri (SILs) is the basis for the application of HPV testing for screening and management of patients. Most infections by HR-HPVs resolve spontaneously, however, and do not progress to dysplasia or cancer. p16INK4a is a useful biomarker of cervical intra-epithelial neoplasia and could be a marker for the progression of low-grade squamous intra-epithelial lesions (LSILs) to high-grade squamous intra-epithelial lesions (HSILs), because it correlates independently with increasing SIL grade. We conducted a preliminary histological study of 28 patients diagnosed with LSIL, HSIL or nondysplastic epithelium (NDE) from whom 28 biopsies of uterine cervix and 28 endocervical brushed biopsies were taken. Argyrophilic nucleolar organizer region (AgNOR) and p16INK4a assays were performed on the biopsies, and endocervical brushings were used for HPV typing. The high risk HPV group showed that the number of patients with AgNOR areas greater than 3.3 μm(2) and with expression of p16INK4a were statistically greater than the number of lower risk patients. None of the biopsies of LR-HPV carriers expressed p16 and AgNOR areas> 3.3 μm(2) simultaneously. Four LSILs and the NDE of this group expressed neither of the two markers. If the correlation between AgNOR areas and p16INK4a is good, we may be able to develop a low cost simple technology for studying patients infected with HR-HPV and diagnosed with LSIL of uncertain behavior.     

Malacoplakia of the uterine cervix. Histologic, cytologic and ultrastructural study of a case

A rare case of malacoplakia of the uterine cervix is described. The histologic, histochemical and ultrastructural findings in this case were typical of this entity. The typical Michaelis-Gutmann bodies were quite easily identified in the cervicovaginal smear with the use of the Von Kossa stain. This method can be an important diagnostic aid in cytologically differentiating this lesion from neoplastic or parasitic processes.     

Retrospective study of Chlamydia trachomatis using the polymerase chain reaction on archival Papanicolaou-stained cytologic smears.

OBJECTIVE: To detect chlamydial DNA on archived Papanicolaou-stained (Pap) smears using the polymerase chain reaction (PCR) technique. STUDY DESIGN: A PCR assay was designed to identify chlamydial DNA using consensus sequences unique to the genus Chlamydia in the 16S rRNA gene. This assay produced a 109 base pair product containing a single Pvu II restriction site. One hundred cervicovaginal Pap smears from a teen clinic population were processed for DNA isolation and PCR. Amplifiable DNA was isolated from 93 of the 100 cases as determined by a human growth hormone gene. These specimens were subjected to chlamydial PCR. RESULTS: PCR analysis of the 93 samples yielded 6 that were positive for the chlamydial 16S rRNA sequence. The six positive chlamydial amplicons were purified and subjected to Pvu II restriction enzyme analysis to validate their identity. The analysis confirmed the identity of the products, as a single Pvu II restriction site resulted in 41 base pair and 68 base pair products, as predicted. CONCLUSION: PCR testing for Chlamydia trachomatis can be performed on DNA isolated from archival Pap smears. Using this methodology, 6.5% of young women in our teen clinic population were positive for chlamydial DNA.     

Prevalence of antibodies to Chlamydia trachomatis in healthy population groups in Manitoba.

The prevalence of antibodies to Chlamydia trachomatis was determined in 1877 serum samples from healthy population groups of Caucasians, native Indians and recent Vietnamese immigrants in Manitoba. Testing was done with a commercially available immunofluorescence kit containing C. trachomatis antigen. The presence of antibodies was age-related; a progressive increase in prevalence was observed in children aged 1 to 15 years, and the overall prevalence was higher in female Caucasian blood donors and female Vietnamese immigrants than in males in both groups. However, there was no sex-related difference in prevalence among the subjects undergoing premarital testing or among the native Indians. Antibodies were more prevalent (p less than 0.001) in pregnant than in nonpregnant women matched for race and age, and a relatively high prevalence (66.6%) was found in the cord serum of newborns. The overall prevalence rate of antibodies in all Manitobans was 48.8% (44.9% in men, 55.9% in women and 35.3% in children.     

Incidence of herpes infection of the uterine cervix observed in cytologic specimens in the Tokyo metropolitan area

In a high-volume cytology laboratory in the metropolitan Tokyo area, the incidence of cytologically diagnosed herpes infection in cervical scraping smears of the female genital tract was studied according to the year-by-year changes, age distribution, seasonal variation and types of cytologic alteration. The overall incidence over the 12 years studied was 0.007% (87 cases among 1,230,773 examined). The incidence varied from 0.003% to 0.005% in the early 1970s (except for 1973) and increased to 0.011% in the last three years (1980 to 1982). A large increase was noted in younger age groups in comparison with middle and older age groups. There was a tendency for the infection rate to be higher in the spring (0.011%) and lower in the fall (0.005%). Multinucleation and a ground-glass appearance were observed in the infected cells in almost every case while eosinophilic inclusion bodies were found in 20.7% of the cases.     

12-Lipoxygenase activity in human uterine cervix

Homogenates prepared from sections of human uterine cervix or endometrium were incubated with [1-14C]arachidonate and the products examined by radio-TLC. A major product chromatographing with 12-hydroxyeicosatetraenoic acid (12-HETE), and a number of more polar metabolites which were unaffected by 50 microM indomethacin but decreased to the same extent as 12-HETE by 50 microM nordihydroguaiaretic acid, were demonstrated by this technique. The addition of glutathione to the incubation mixture increased the production of 12-HETE, with a proportional decrease in the polar products. There was a large variation in 12-lipoxygenase activity measured in different cervix samples. The levels of the enzyme in the cervix were similar in two groups of uterine samples classified by the histological appearance of the endometrium as proliferative and secretory. However activity was significantly lower in samples taken from post-menopausal patients compared with pre-menopausal patients.