Urbanization and baseline prevalence of genital infections including Candida, Trichomonas, and human papillomavirus and of a disturbed vaginal ecology as established in the Dutch Cervical Screening Program.
OBJECTIVE
An overgrowth of coccoid bacilli in the absence of lactobacilli (bacterial vaginosis) is considered a sign of a "disturbed" vaginal ecologic system. The aim of this study was to establish the baseline prevalence of genital infections and of a disturbed vaginal ecologic system and their relationship to urbanization.


METHODS
More than 190,000 cervical smears were screened by 1 cytology laboratory in the context of the Dutch national screening programs. The women who were symptom free and had been registered in the statutory files of municipal units were screened by invitation. Urbanization (place of residence) was derived from the postal code. To investigate a trend in prevalence in relation to urbanization, Schaafsma's method was used.


RESULTS
Bacterial vaginosis had the highest score per 1000 screened women (36.1), followed by Candida (12.6). Higher prevalence of human papillomavirus, bacterial vaginosis, and Trichomonas was related to urbanization as was, whereas Candida was not.


CONCLUSIONS
Human papillomavirus and Trichomonas are more frequently found in women who live in the large cities, which in The Netherlands also harbor the high-risk population for premalignant cytologic evidence. Our findings concerning the baseline prevalence pattern of bacterial vaginosis support the hypothesis of the importance of a disturbed bacterial ecologic system in cervical carcinogenesis.
Leiden Cytology and Pathology Laboratory, the Department of Pathology, Leiden University Medical Center, The Netherlands. m.e.boon@lcpl.nl
Mathilde E
ME
Boon
Hedda H
HH
van Ravenswaay Claasen
Lambrecht P
LP
Kok
D000328:Adult; D000818:Animals; D002175:Candida / Q000302:isolation & purification; D002177:Candidiasis / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D005831:Genital Diseases, Female / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000382:microbiology*; D015995:Prevalence; D014244:Trichomonas / Q000302:isolation & purification; D014245:Trichomonas Infections / Q000453:epidemiology / Q000382:microbiology*; D014505:Urban Population; D016585:Vaginosis, Bacterial / Q000453:epidemiology / Q000382:microbiology*