Infecciones vaginales y lesiones celulares cervicales(I). Programa de cribado de otras infecciones y ETS simultáneas

Objective

To evaluate a screening program for simultaneous detection of sexually-transmitted diseases and other infections in women with vaginal infections and cervical cell abnormalities diagnosed by cervicovaginal cytology.

Material and methods

There were 399 women with vaginal infections due to the following: Candida (95 cases), bacterial vaginosis (234 cases), Gardnerella vaginalis (14 cases), Candida plus bacterial vaginosis (9 cases), Trichomonas vaginalis (9 cases), bacterial vaginosis plus Trichomonas (1 case), human papillomavirus (HPV) (16 cases), and a history of HPV infection (21 cases). Thirty-two women had cervical cell abnormalities: atypical squamous cells of undetermined significance (ASCUS) (7 cases), atypical glandular cells of undetermined significance (AGUS) (1 case), low-grade squamous intraepithelial lesion (LSIL) (22 cases) and high-grade squamous intraepithelial lesion (HSIL) (2 cases). Analysis included erythrocyte sedimentation rate (ESR), C reactive protein (CRP), leukocyte count and lymphocyte count; HBsAg serology, hepatitis C virus (HCV) antibodies, HIV antibodies, herpes simplex virus (HSV)-2 antibodies, rapid plasma reagin (RPR), and DNA-HPV probe (Digene HPV) for high-risk (HR) and low-risk (LR) HPV.

Results

A total of 131 women (30.39%) were foreigners. The most frequent infections were bacterial vaginosis, with 234 cases (58.64%), and Candida infections with 95 cases (23.80%). HPV, a history of HPV and cervical abnormalities affected the younger women; among this group, there were fewer pregnancies and deliveries and a greater number of nulligravidas. Bacterial vaginosis and Candida infections affected the older women. Candida plus bacterial vaginosis showed lower CRP concentrations, and higher leukocyte count, indicating a greater response to mixed infection. With Trichomonas, lymphocyte levels were low, indicating immunodepression. The data on HPV types were as follows: the highest values were found in HPV (HR in 68.75% and LR in 62.5%), and in those with antecedents of HPV HR in 52.38% and LR in 23.80%]. In LSIL, 72.72% were HR and 31.81% were LR. The two cases of HSIL were HR. Serology detected 33 cases of HSV-2 (7.65%), 3 cases of HBsAg (0.69%), 4 cases of HCV (0.92%), and 1 case of HIV and syphilis each (0.23%).

Conclusions

Screening for STD and other infections is recommended in the general population, especially in groups at high risk and showing a high prevalence of these infections, such as younger persons, in whom we identified previously undetected HPV. We recommend vaccination in cases with negative results on DNA-HPV probe, independently of age. Serology also identified known, as well as previously unknown, infections with HIV, syphilis, and hepatitis B and C viruses, demonstrating the value of screening, and allowing these infections to be treated and followed-up.In summary, we recommended screening programs for STD and other infections in women with a diagnosis of vaginal infection or cervical abnormalities in Papanicolaou cytology.