Cervicovaginal infections in the Papanicolaou test of asymptomatic patients
Keywords:
bacterial vaginosis, HPV infection, Papanicolaou test.Abstract
Introduction: The Papanicolaou test studies the exfoliated cells of the squamo-columnar junction of the cervix for the detection of abnormal cells and is also useful for the diagnosis of cervicovaginal infections.
Objective: To characterize patients with asymptomatic cervicovaginal infections diagnosed by Papanicolaou test.
Methods: An observational, descriptive and cross-sectional investigation was carried out in 656 patients with asymptomatic cervicovaginal infection, diagnosed by Papanicolaou test. The following were studied: Germs, age, initiation of sexual relations, number of sexual partners, anomalies of cervical epithelial cells. The information was obtained through interrogation, clinical examination and Papanicolaou test. Descriptive statistical techniques were used to calculate absolute frequencies, percentages, mean and standard deviation.
Result: A predominance of bacterial vaginosis was found (46 %), followed by Candida spp infection (38.2 %). The average age of the patients was 36.4 years. It was observed that in 244 women the age at which sexual relations began was 16 - 20 years (37.2 %). 531 cases (80.9 %) had an active sexual partner. 86 % did not present cervical lesions, but 72.7 % of HPV infections did.
Conclusions: The majority of women have bacterial vaginosis, they are adults, with early onset of sexual relations and an active sexual partner. Most of them do not have cervical lesions, the majority, with HPV infection, have anomalies of the cervical epithelial cells.
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References
1. Chávez Frías M, García Blanco L, Chaves Sotelo J, Duran K, Ramírez J. Prevalencia de infecciones vaginales en mujeres embarazadas y no embarazadas en un hospital de Cali, Colombia. Revista Ciencias Biomédicas. 2020; 9(2): 92-102.DOI: 10.32997/rcb-2020-3157
2. Villarreal Ríos E, Benítez Benítez S, Vargas Daza ER, Martínez González L, Galicia Rodríguez L, Escorcia Reyes V. Incidencia de infecciones cervicovaginales diagnosticadas por citología y no tratadas médicamente. Ginecol Obstet Mex. 2018 Mar [acceso: 21/01/2022];86(3):186-192.Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S030090412018000300004&lng=es&nrm=iso&tlng=es
3. López Pérez M, Palma Mora S, García Gómez D. Infecciones cervicovaginales en pacientes sintomáticas atendidas en la Consulta externa de Ginecología. Acta Médica del Centro. 2019 [acceso:05/05/2023];14(1):[aprox.6p.].Disponible en: http://www.revactamedicacentro.sld.cu/index.php/amc/article/view/1151
4. Spengler González L, Ayala Rodríguez I, García Rodríguez A. Infecciones cervicovaginales en exudados vaginales. Revista Cubana de Medicina Militar. 2020 [acceso:05 /05 /2022]; 49 (3): e578.Disponible en: http://www.revmedmilitar.sld.cu/index.php/mil/article/view/578
5. Marconi C, El-Zein M, Ravel J, Ma B, Lima MD, Carvalho NS, et al. Characterization of the vaginal microbiome in women of reproductive age from five regions in Brazil. SexTransm Dis. 2020 [acceso: 05/05/2023];47(8): 562-9. DOI: 10.1097/olq.0000000000001204
6. Graves KJ, Ghosh AP, Kissinger PJ, Muzny CA. Trichomonas vaginalis virus: a review of the literature. Int J STD AIDS. 2019 [acceso: 21/05/2023];30(5): 496-504.DOI: 10.1177/0956462418809767
7. Palma Osorio M, Romero Flores A, Torres Mesa A. Factores de riesgo en las lesiones intraepiteliales del cuello uterino. Revista Finlay. 2019 [acceso: 05/05/2022]; 9(4): [aprox. 14 p.]. Disponible en: http://revfinlay.sld.cu/index.php/finlay/article/view/693
8. Meléndez Mogollón IC, Camero Solórzano YB, Sánchez Pérez EE, Álvarez Granoble D. Conocimiento sobre el Virus de Papiloma Humano en mujeres sexualmente activas. Revista Cuatrimestral "Conecta Libertad". 2019 [acceso: 09/05/2022];3(1):24-34. Disponible en: https://revistaitsl.itslibertad.edu.ec/index.php/ITSL/article/view/69
9. Fodor M, Nasio C, Olmos M, Alonso E. Citología cervicovaginal en mujeres mayores de 50 años. Revista Médica de Rosario. 2021 [acceso: 09/05/2022]; 86(3): 117-122. Disponible en: https://revistamedicaderosario.org/index.php/rm/article/view/108
10. Pereira Cabral VC, Sousa de Souza B, Dias Martins L. Cytologic aspects between pap smear and pregnancy. Research, Society and Development. 2021; 10(11):e500101120015. DOI: 10.33448/rsd-v10i11.20015
11.Pangarkar MA. The Bethesda System for reporting cervical cytology. Cytojournal. 2022 [acceso: 28/07/2022];19(28): [aprox.11 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9168399/
12. Organización Mundial de la Salud. World Medical Association Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subjects. Washington: OMS; 2001. [acceso: 10/02/2023]. Disponible en: http://www.who.int/bulletin/archives/79(4)373.pdf
13. O'Hanlon DE, Gajer P, Brotman RM, Ravel J. Asymptomatic bacterial vaginosis is associated with depletion of mature superficial cells shed from the vaginal epithelium. Front Cell Infect Microbiol. 2020; 10:106. DOI: 10.3389/fcimb.2020.00106
14. Fajardo EF, Braz GR, Rosa M, Marques T, Gomes BBM, Mantello Bianco T, et al. Prevalence of Vaginal Infections in Women under Screening to HPV infection and cervical Lesions in Brazilian Basic Health Service. Int Arch Med Microbiol. 2018 [acceso: 05/05/2023]; 1(1):1-5. Disponible en: https://www.researchgate.net/publication/330020472_Prevalence_of_Vaginal_Infections_in_Women_under_Screening_to_HPV_Infection_and_Cervical_Lesions_in_Brazilian_Basic_Health_Service
15. Carvalho F S, Porto N K A, Azevedo P V M, Magalhães P K A, Araújo E N de, Correia M S, et al. Agents causing genital infections in routine cytological tests: frequency and characteristics of Papanicolaou smears. Braz J. Biol. 2021; 82: e238180. DOI: 10.1590/1519-6984.238180
16. Ghosh S, Pattanshetty SM, Mallya SD, Pandey D, Guddattu V, Kamath VG, et al. Cervical cytology and associated factors among tribal women of Karnataka, India. PLOS ONE.2021; 16(3): e0248963. DOI: 10.1371/journal.pone.0248963
17. Jayapalan S, Bindu RS. Papanicolaou smear: A diagnostic aid in sexually transmitted infections. Indian J Sex Transm Dis AIDS. 2020 [acceso: 22/06/2022]; 41(2):143-8. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000682/
18. Ahmad I, Nirala RK, Poddar CK, Chaudhary PK. Comparative Study of PAP Smear and Microbiological Pattern in Bacterial Vaginosis in a Tertiary Care Hospital, South Bihar (India). International Journal of Contemporary Medical Research. 2018; 5(12): 5 -10. DOI: 10.21276/ijcmr.2018.5.12.25
19. Rina Kawahara, Takuma Fujii, Iwao Kukimoto, Hiroyuki Nomura, Rie Kawasaki, Eiji Nishio, et al. Changes to the cervicovaginal microbiota and cervical cytokine profile following surgery for cervical intraepithelial neoplasia. Scientific Reports. 2021; 11: 2156. DOI: 10.1038/s41598-020-80176-6
20. Abdul-Aziz M, Mahdy MAK, Abdul-Ghani R, Alhilali NA, Al-Mujahed LKA, Alabsi SA, et al. Bacterial vaginosis, vulvovaginal candidiasis and trichomonal vaginitis among reproductive-aged women seeking primary healthcare in Sana'a city, Yemen. BMC Infect Dis. 2019 [acceso: 09/05/2022]; 19(1): 879. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31640583/
21. Aragão FBA, Santos GRB dos, Lobão WJM de, Oliveira AP de, Monteiro SG, Santos LM, et al. Associação do perfil microbiológico com alterações citológicas em mulheres quilombolas atendidas nas unidades básicas de saúde. Medicina (Ribeirão Preto). 2019 [acceso: 05/05/2023]; 52(4):311-8. Disponible: https://www.revistas.usp.br/rmrp/article/view/156929
22. Leite RR, dos Santos AM, Miranda SS, Pimenta RMC, Silva MVCM, Vicentini F, et al. Perfil epidemiológico de mulheres quilombolas submetidas ao exame citopatológico preventivo. Rev Epidemiol Control Infect. 2021 [acceso: 21/06/2022];11(3). [aprox. 14 p.]. Disponible en: https://online.unisc.br/seer/index.php/epidemiologia/article/view/16688
23. Zapata Martínez JF, Muñoz AP, Tirado Otálvaro AF, González JD, Velásquez Vergara SM. Factores de riesgo asociados a infecciones vaginales y lesiones escamosas intraepiteliales en estudiantes universitarias de Medellín - Colombia. Enfermería Global. 2018; 17(2):86-96. DOI: 10.6018/EGLOBAL.17.2.275881
24. Emegoakor FCJ, Okafor OC, Ugwu OM, Okolie EV, Molokwu C, Orji C, et al. Asymptomatic cacterial vaginosis in cervical cytology: A preliminary report of incidental finding in routine cervical cancer screening. Open Journal of Obstetrics and Gynecology. 2020; 10(10):1471-81.DOI: 10.4236/ojog.2020.10100134
25. Ferrá Torres T. Determinación de la incidencia de infecciones de transmisión sexual en la Consulta Infanto-Juvenil. Archivo Médico Camagüey. 2021 [acceso: 16/06/2022]; 25(5): [aprox. 9 p.]. Disponible en: http://revistaamc.sld.cu/index.php/amc/article/view/8097
26. Itarat Y, Kietpeerakool C, Jampathong N, Chumworathayi B, Kleebkaow P, Aue-aungkul A, et al. Sexual behavior and infection with cervical human papillomavirus types 16 and 18. Int J Women Health. 2019; 11: 489-494.DOI: 10.2147/IJWH.S218441
27. Anand KV, Pimple SA, Mishra GA, Sahare RV, Pathuthara S, Deodhar KK, et al. Reliability of conventional Papanicolaou smear in diagnosing bacterial vaginosis among women with clinical genital infection. South Asian J Cancer. 2020[acceso:05/05/2023]; 9(1): 13-16. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6956588/
28. Romero Morelos P, Bandala C, Jiménez Tenorio J, Valdespino Zabala M, Rodríguez Esquivel M, Gama Ríos RA, et al. Bacterias relacionadas con vaginosis bacteriana y su asociación a la infección por virus del papiloma humano. Medicina Clínica. 2019 [acceso: 28/07/2022];152(1):1-5. Disponible en: https://www.sciencedirect.com/science/article/pii/S0025775318300873
29. Quispe Gómez M, Valencia Vera C, Rodríguez Figueroa A, Salazar Quispe P. Factores de riesgo asociados a lesiones precancerosas del cuello uterino en pacientes atendidas en consultorio de ginecología Hospital Víctor Ramos Guardia Huaraz, 2014-2015. Aporte Santiaguino. 2018;11(1): 81-94. DOI: 10.32911/as. 2018.v11. n1.458
30. Sanchez Garcia EK, Contreras Paredes A, Martinez Abundis E, Garcia Chan D, Lizano M, de la cruz Hernandez E. Molecular Epidemiology of Bacterial Vaginosis and its association with genital micro-organisms in asymptomatic women. Journal of Medical Microbiology. 2019; 68(9): 1373-1382. DOI: 10.1099/jmm.0.001044
31. Norenhag J, Du J, Olovsson M, Verstraelen H, Engstrand L, Brusselaers N. The vaginal microbiota, human papillomavirus and cervical dysplasia: A systematic review and network metaanalysis. BJOG. 2020; 127(2):171-80.DOI: 10.1111/1471-0528.15854
32. Lin W, Zhang Q, Chen Y, Chen L, Dong B, Sun P. The prevalence of human papillomavirus and bacterial vaginosis among young women in China: a cross-sectional study. BMC Women's Health. 2021; 21(1): 409. DOI: 10.1186/s12905-021-01504-0
2. Villarreal Ríos E, Benítez Benítez S, Vargas Daza ER, Martínez González L, Galicia Rodríguez L, Escorcia Reyes V. Incidencia de infecciones cervicovaginales diagnosticadas por citología y no tratadas médicamente. Ginecol Obstet Mex. 2018 Mar [acceso: 21/01/2022];86(3):186-192.Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S030090412018000300004&lng=es&nrm=iso&tlng=es
3. López Pérez M, Palma Mora S, García Gómez D. Infecciones cervicovaginales en pacientes sintomáticas atendidas en la Consulta externa de Ginecología. Acta Médica del Centro. 2019 [acceso:05/05/2023];14(1):[aprox.6p.].Disponible en: http://www.revactamedicacentro.sld.cu/index.php/amc/article/view/1151
4. Spengler González L, Ayala Rodríguez I, García Rodríguez A. Infecciones cervicovaginales en exudados vaginales. Revista Cubana de Medicina Militar. 2020 [acceso:05 /05 /2022]; 49 (3): e578.Disponible en: http://www.revmedmilitar.sld.cu/index.php/mil/article/view/578
5. Marconi C, El-Zein M, Ravel J, Ma B, Lima MD, Carvalho NS, et al. Characterization of the vaginal microbiome in women of reproductive age from five regions in Brazil. SexTransm Dis. 2020 [acceso: 05/05/2023];47(8): 562-9. DOI: 10.1097/olq.0000000000001204
6. Graves KJ, Ghosh AP, Kissinger PJ, Muzny CA. Trichomonas vaginalis virus: a review of the literature. Int J STD AIDS. 2019 [acceso: 21/05/2023];30(5): 496-504.DOI: 10.1177/0956462418809767
7. Palma Osorio M, Romero Flores A, Torres Mesa A. Factores de riesgo en las lesiones intraepiteliales del cuello uterino. Revista Finlay. 2019 [acceso: 05/05/2022]; 9(4): [aprox. 14 p.]. Disponible en: http://revfinlay.sld.cu/index.php/finlay/article/view/693
8. Meléndez Mogollón IC, Camero Solórzano YB, Sánchez Pérez EE, Álvarez Granoble D. Conocimiento sobre el Virus de Papiloma Humano en mujeres sexualmente activas. Revista Cuatrimestral "Conecta Libertad". 2019 [acceso: 09/05/2022];3(1):24-34. Disponible en: https://revistaitsl.itslibertad.edu.ec/index.php/ITSL/article/view/69
9. Fodor M, Nasio C, Olmos M, Alonso E. Citología cervicovaginal en mujeres mayores de 50 años. Revista Médica de Rosario. 2021 [acceso: 09/05/2022]; 86(3): 117-122. Disponible en: https://revistamedicaderosario.org/index.php/rm/article/view/108
10. Pereira Cabral VC, Sousa de Souza B, Dias Martins L. Cytologic aspects between pap smear and pregnancy. Research, Society and Development. 2021; 10(11):e500101120015. DOI: 10.33448/rsd-v10i11.20015
11.Pangarkar MA. The Bethesda System for reporting cervical cytology. Cytojournal. 2022 [acceso: 28/07/2022];19(28): [aprox.11 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9168399/
12. Organización Mundial de la Salud. World Medical Association Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subjects. Washington: OMS; 2001. [acceso: 10/02/2023]. Disponible en: http://www.who.int/bulletin/archives/79(4)373.pdf
13. O'Hanlon DE, Gajer P, Brotman RM, Ravel J. Asymptomatic bacterial vaginosis is associated with depletion of mature superficial cells shed from the vaginal epithelium. Front Cell Infect Microbiol. 2020; 10:106. DOI: 10.3389/fcimb.2020.00106
14. Fajardo EF, Braz GR, Rosa M, Marques T, Gomes BBM, Mantello Bianco T, et al. Prevalence of Vaginal Infections in Women under Screening to HPV infection and cervical Lesions in Brazilian Basic Health Service. Int Arch Med Microbiol. 2018 [acceso: 05/05/2023]; 1(1):1-5. Disponible en: https://www.researchgate.net/publication/330020472_Prevalence_of_Vaginal_Infections_in_Women_under_Screening_to_HPV_Infection_and_Cervical_Lesions_in_Brazilian_Basic_Health_Service
15. Carvalho F S, Porto N K A, Azevedo P V M, Magalhães P K A, Araújo E N de, Correia M S, et al. Agents causing genital infections in routine cytological tests: frequency and characteristics of Papanicolaou smears. Braz J. Biol. 2021; 82: e238180. DOI: 10.1590/1519-6984.238180
16. Ghosh S, Pattanshetty SM, Mallya SD, Pandey D, Guddattu V, Kamath VG, et al. Cervical cytology and associated factors among tribal women of Karnataka, India. PLOS ONE.2021; 16(3): e0248963. DOI: 10.1371/journal.pone.0248963
17. Jayapalan S, Bindu RS. Papanicolaou smear: A diagnostic aid in sexually transmitted infections. Indian J Sex Transm Dis AIDS. 2020 [acceso: 22/06/2022]; 41(2):143-8. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000682/
18. Ahmad I, Nirala RK, Poddar CK, Chaudhary PK. Comparative Study of PAP Smear and Microbiological Pattern in Bacterial Vaginosis in a Tertiary Care Hospital, South Bihar (India). International Journal of Contemporary Medical Research. 2018; 5(12): 5 -10. DOI: 10.21276/ijcmr.2018.5.12.25
19. Rina Kawahara, Takuma Fujii, Iwao Kukimoto, Hiroyuki Nomura, Rie Kawasaki, Eiji Nishio, et al. Changes to the cervicovaginal microbiota and cervical cytokine profile following surgery for cervical intraepithelial neoplasia. Scientific Reports. 2021; 11: 2156. DOI: 10.1038/s41598-020-80176-6
20. Abdul-Aziz M, Mahdy MAK, Abdul-Ghani R, Alhilali NA, Al-Mujahed LKA, Alabsi SA, et al. Bacterial vaginosis, vulvovaginal candidiasis and trichomonal vaginitis among reproductive-aged women seeking primary healthcare in Sana'a city, Yemen. BMC Infect Dis. 2019 [acceso: 09/05/2022]; 19(1): 879. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31640583/
21. Aragão FBA, Santos GRB dos, Lobão WJM de, Oliveira AP de, Monteiro SG, Santos LM, et al. Associação do perfil microbiológico com alterações citológicas em mulheres quilombolas atendidas nas unidades básicas de saúde. Medicina (Ribeirão Preto). 2019 [acceso: 05/05/2023]; 52(4):311-8. Disponible: https://www.revistas.usp.br/rmrp/article/view/156929
22. Leite RR, dos Santos AM, Miranda SS, Pimenta RMC, Silva MVCM, Vicentini F, et al. Perfil epidemiológico de mulheres quilombolas submetidas ao exame citopatológico preventivo. Rev Epidemiol Control Infect. 2021 [acceso: 21/06/2022];11(3). [aprox. 14 p.]. Disponible en: https://online.unisc.br/seer/index.php/epidemiologia/article/view/16688
23. Zapata Martínez JF, Muñoz AP, Tirado Otálvaro AF, González JD, Velásquez Vergara SM. Factores de riesgo asociados a infecciones vaginales y lesiones escamosas intraepiteliales en estudiantes universitarias de Medellín - Colombia. Enfermería Global. 2018; 17(2):86-96. DOI: 10.6018/EGLOBAL.17.2.275881
24. Emegoakor FCJ, Okafor OC, Ugwu OM, Okolie EV, Molokwu C, Orji C, et al. Asymptomatic cacterial vaginosis in cervical cytology: A preliminary report of incidental finding in routine cervical cancer screening. Open Journal of Obstetrics and Gynecology. 2020; 10(10):1471-81.DOI: 10.4236/ojog.2020.10100134
25. Ferrá Torres T. Determinación de la incidencia de infecciones de transmisión sexual en la Consulta Infanto-Juvenil. Archivo Médico Camagüey. 2021 [acceso: 16/06/2022]; 25(5): [aprox. 9 p.]. Disponible en: http://revistaamc.sld.cu/index.php/amc/article/view/8097
26. Itarat Y, Kietpeerakool C, Jampathong N, Chumworathayi B, Kleebkaow P, Aue-aungkul A, et al. Sexual behavior and infection with cervical human papillomavirus types 16 and 18. Int J Women Health. 2019; 11: 489-494.DOI: 10.2147/IJWH.S218441
27. Anand KV, Pimple SA, Mishra GA, Sahare RV, Pathuthara S, Deodhar KK, et al. Reliability of conventional Papanicolaou smear in diagnosing bacterial vaginosis among women with clinical genital infection. South Asian J Cancer. 2020[acceso:05/05/2023]; 9(1): 13-16. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6956588/
28. Romero Morelos P, Bandala C, Jiménez Tenorio J, Valdespino Zabala M, Rodríguez Esquivel M, Gama Ríos RA, et al. Bacterias relacionadas con vaginosis bacteriana y su asociación a la infección por virus del papiloma humano. Medicina Clínica. 2019 [acceso: 28/07/2022];152(1):1-5. Disponible en: https://www.sciencedirect.com/science/article/pii/S0025775318300873
29. Quispe Gómez M, Valencia Vera C, Rodríguez Figueroa A, Salazar Quispe P. Factores de riesgo asociados a lesiones precancerosas del cuello uterino en pacientes atendidas en consultorio de ginecología Hospital Víctor Ramos Guardia Huaraz, 2014-2015. Aporte Santiaguino. 2018;11(1): 81-94. DOI: 10.32911/as. 2018.v11. n1.458
30. Sanchez Garcia EK, Contreras Paredes A, Martinez Abundis E, Garcia Chan D, Lizano M, de la cruz Hernandez E. Molecular Epidemiology of Bacterial Vaginosis and its association with genital micro-organisms in asymptomatic women. Journal of Medical Microbiology. 2019; 68(9): 1373-1382. DOI: 10.1099/jmm.0.001044
31. Norenhag J, Du J, Olovsson M, Verstraelen H, Engstrand L, Brusselaers N. The vaginal microbiota, human papillomavirus and cervical dysplasia: A systematic review and network metaanalysis. BJOG. 2020; 127(2):171-80.DOI: 10.1111/1471-0528.15854
32. Lin W, Zhang Q, Chen Y, Chen L, Dong B, Sun P. The prevalence of human papillomavirus and bacterial vaginosis among young women in China: a cross-sectional study. BMC Women's Health. 2021; 21(1): 409. DOI: 10.1186/s12905-021-01504-0
Published
2024-02-15
How to Cite
1.
Bonachea Peña RR, José Maria Bráz FDR, Hernández Veitía MJ, Hernández Veitía Y, Gonçalves da Cruz A. Cervicovaginal infections in the Papanicolaou test of asymptomatic patients. Rev Cubana Med Milit [Internet]. 2024 Feb. 15 [cited 2025 Apr. 4];53(1):e024017620. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/17620
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