title: Bacterial vaginosis, aerobic vaginitis, vaginal inflammation and major Pap smear abnormalities.
abstract: The purpose of this investigation was to evaluate the impact of the vaginal milieu on the presence of abnormal Pap smears and a positive human papilloma virus (HPV) test. A cross-sectional study was conducted between June 2014 and May 2015, evaluating the vaginal discharge by fresh wet mount microscopy and comparing these data with Pap smear findings. Wet mount slides were scored for bacterial vaginosis (BV), aerobic vaginitis (AV), presence of Candida and Trichomonas vaginalis. Cytologic evaluation was done on all Pap smears according to the Bethesda criteria. The cobas© HPV Test (Roche) was performed for HPV detection. A total of 622 cases were evaluated. The mean age of the patients was 41.6 ± 10.65 years (range 21-75). Eighty-three women (13.3 %) had a cytology result worse than low-grade squamous intraepithelial lesion (LSIL). When comparing this group with the one with normal or minor [atypical squamous cells of undetermined significance (ASC-US) or LSIL] Pap smear abnormalities, there were no differences in the presence of Candida (32.5 % vs. 33.2 %, p = 1.0), absence of lactobacilli (38.6 % vs. 32.5 %, p = 0.32) or BV (20.5 % vs. 13.2 %, p = 0.09). On the other hand, moderate or severe inflammation (msI) (41.0 % vs. 28.8 %, p = 0,04), moderate or severe AV (msAV) (16.9 % vs. 7.2 %, p = 0.009) and msAV/BV (37.3 % vs. 20.0 %, p = 0.001) were more common in women with such major cervical abnormalities. No significant association was found between deviations of the vaginal milieu and high-risk HPV infection. The presence of msI or msAV, but not BV, is independently associated with an increased risk of major cervical cytological abnormalities, but not with HPV infection.
authors.affiliation: Department of Gynecology and Obstetrics, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200, Porto, Portugal. pedrovieirabaptista@gmail.com.
authors.forename: P
authors.identifier: http://orcid.org/0000-0001-5335-6770
authors.initials: P
authors.lastname: Vieira-Baptista
authors.affiliation: Department of Gynecology and Obstetrics, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200, Porto, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Lima-Silva
authors.affiliation: Department of Gynecology and Obstetrics, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200, Porto, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Pinto
authors.affiliation: LAP-Laboratório de Anatomia Patológica, Unilabs, Porto, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Saldanha
authors.affiliation: Department of Gynecology and Obstetrics, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200, Porto, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Beires
authors.affiliation: Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.|Department of Children and Women's Health, Centro Hospitalar da Cova da Beira, Covilhã, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Martinez-de-Oliveira
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Antwerp, Antwerp, Belgium.|Femicare Clinical Research for Women, Tienen, Belgium.
authors.forename: G
authors.initials: G
authors.lastname: Donders
mesh_terms: D000328:Adult; D000368:Aged; D002181:Candidiasis, Vulvovaginal / Q000150:complications*; D003430:Cross-Sectional Studies; D005260:Female; D061809:Human Papillomavirus DNA Tests; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology*; D014247:Trichomonas Vaginitis / Q000150:complications*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology*; D016585:Vaginosis, Bacterial / Q000150:complications*; D055815:Young Adult
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