engleski

Sexually transmitted diseases in severe cervical dysplasia

To determine the occurrence and persistance of sexually transmitted deseases (STD) in patients with severe cervical dysplasia, before and after conisation. Methods: In 74 patients, undergoing conisation for severe cervical dysplasia (ranging from CIN II to invasive carcinoma), PAP smear analysis for the incidence of STD was performed. Standard morphological criteria were used for tha analysis: koilocytosis, binucleation and parakeratosis for HPV infection, cytoplasmatic vacuolisation with presence of nebular and infectious bodies for Chlamydia trachomatis, and clue cells for Gardnerella vaginalis. Early cytological abnormalities, recurrent cervical dysplasia and STD were followed-up for the period of one to 36 months after conisation. Results: Before conisation: 36/74 (48.6%) patients were morphologicaly positive for HPV, among them 29/36 (80.5%) with coexistance of mixed bacterial flora, 1/36 (2.8%) with funghi and 1/36 (2.8%) with Chlamydia trachomatis. Mixed bacterial flora was present in 19/74 (25.7%) of smears. One/74 (1.3%) was positive for Chlamydia trachomatis, 2/74 (2.7%) for funghi and 1/74(1.3%) for Gardnerella vaginalis. Bacillus vaginalis was present in 14/74(18.9%) cases. Considering the distribution of HPV infection, 28/36(77.8%) were present in patients with CINIII and CIS, 6/36(16.7%) in CIN II and 2/36 (5.5%) revealed PHD negative for cervical dysplasia. After conisation: the first cytological control smear, taken one to six months, showed 18/74 (24.3%) patients had positive Pap smear for dysplasia ranged from ASCUS to CIS. Eight of them were positive for HPV with coexistance of mixed bacterial flora before operation, and only one was positive for HPV after procedure, remaining positive up to 24 months. Although 11/74 (14.8%) patients showed no abnorrmalities at first cytological control, in the next 24 months they developed reccurent desease, ranging ASCUS to CIN I, with reinfection in 3/11(27.3%) cases for HPV, and one for Chlamydia trachomatis, all HPV positive before conisation. Conclusion: There is high incidence of STD in severe cervical dysplasia, with HPV infection increasing with severity of SIL. In patients with HPV infection and severe cervical dysplasia, coinfection with mixed bacterial flora may have an additional role in cervical carcinogenesis.

Sexually transmitted disease; cervical dysplasia

nije evidentirano