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PubMed1949

The clinical usefulness of the vaginal smear.

The chief value of the vaginal smear is as a simple, rapid means of accelerating the diagnosis of cancer in those cases in which the presenting symptoms or lesions are not sufficiently alarming to provoke immediate surgical investigation. Carcinoma of the endocervix, carcinoma in situ, and carcinoma existing together with inflammatory and scarifying lesions are most likely to be discovered by the method. The very early ulcerative malignancy, before the fibrous proliferative reaction produces the classical raised edge and granular base, also has been detected on the smear taken just before the cautery was applied. The small nubbin without ulceration also yields malignant cells. These lesions almost always include the surface epithelium. The positive smear has induced the immediate repetition of biopsy or curettage when the first sections have not confirmed a clinical suspicion. It can prevent temporizing when there is an easy explanation (such as estrogen administration or menopausal irregularity) for spotting and metrorrhagia. Examination of smears has corrected a number of false impressions caused by poor visualization. The smear method is irreplaceable for the early diagnosis of recurrence after radiation. Salvage of the patient is rarely to be expected from such a discovery, but planning of palliative therapy is greatly aided.

Biopsy↗
PubMed1982

Superficial eosinophilic squamous epithelial cells in vaginal smears from postmenopausal women.

19 500 vaginal smears from women aged 20-90 years were examined from August 1976 to November 1979. 3 000 were from women more than 55 years of age. 146 of these had smears with an increased proportion of superficial eosinophilic squamous epithelial cells (SESEC). The smears were divided into four groups, A-D with 0-25%, 25-50%, 50-75% and 75-100% of SESEC of the examined squamous epithelial cells. 39% of the 146 with increased proportions of SESEC were either undergoing treatment with estrogenic hormones, or else the possibility of estrogenic influence could not be ruled out. In group D the possibility of an estrogenic influence was more pronounced, here found to be 67%. In 32% of the 146 cases we believe that these cells were possibly the result of changed anatomical conditions in the cervix/vagina. Such an explanation seems most frequently probable in groups A and B. In 5% of the 146 cases the cells appeared changed, as can be seen in trichomoniasis. In 21% the discovery of the cells could not be explained. Finally, no explanation could be found for 5% in group D.

Age Factors↗
PubMed2004

Reliability of interpretation of gram-stained vaginal smears by Nugent's scoring system for diagnosis of bacterial vaginosis.

This study was designed to assess reliability of interpretation of Gram-stained vaginal smears by using Nugent's scoring system for diagnosis of bacterial vaginosis (BV) across three different centers in Turkey: two in Ankara and one in Trabzon. The vaginal smears were collected from clients attending a family planning clinic in Trabzon, Turkey during October-December 1997. One slide taken from each client was prepared according to the standard methods and enumerated. One evaluator from each center examined the slides independently for the presence of BV and none of them had access to the evaluation of the others. Out of 372 slides, 301 (81%) were found to be satisfactory for scoring by all three evaluators and included in the analysis. Nugent's scores from 1-10 reported from each evaluator were compared by Spearman correlation coefficients and Kappa statistics. The difference in the proportions of BV diagnosis in three centers was evaluated by chi2 test. There was good agreement for the interpretation of Gram-stained vaginal smears by Nugent's scoring system for diagnosis of BV. These results indicate that it is a reliable method in diagnosis of BV at different settings.

Female↗
PubMed2004

[Diagnostic value of Gram stain for assessment of vaginal smears during pregnancy].

The main aim of this study was to compare the diagnostic value of Giemsa stained method with Gram stained method for the evaluation of vaginal smears among pregnant women. A study population comprised 111 pregnant between 6 and 30 weeks of gestation. The vaginal smears from every subject was diagnosed according to Giemsa and Gram stained method and micro-organisms were isolated by culture. In 29.3% cases diagnosed as normal flora (2a) on the basis of Giemsa method bacterial vaginosis was detected in Gram stains according to Spiegel's criteria and pathological microflora in concentration > or = 10(5) CFU/ml was cultured among 75.9% of them. Among 31.7% women who had grade 3a (abnormal) in Giemsa stains method normal flora was diagnosed on the basis on Gram's method and from 17.1% pregnant women from this group we did not isolated any pathogens. For evaluation of vaginal smears during pregnancy the Giemsa method should be replaced by Gram stained method.

Azure Stains↗
PubMed1991

An indirect immunofluorescence method for detection of Mycoplasma hominis in vaginal smears.

We developed a novel method for the detection of Mycoplasma hominis from vaginal swabs using an indirect immunofluorescence technique. It is a rapid and simple method that can be finished in only 5 hr and is more sensitive than the usual culture isolation method. The indirect immunofluorescence method was applied to vaginal smears from 193 healthy women and 33.7% gave a positive test. This value was much higher than that (11.4%) obtained from the same specimens by the culture method. When vaginal smears were subjected to Papanicolaou staining after the indirect immunofluorescence method, the specific immunofluorescence of the epithelial cells was located exactly at the sites of granular aggregates stained with Papanicolaou stain. A histological examination by Papanicolaou staining showed that the incidence of inflammation seems to be slightly higher in M. hominis-carriers than in non-carriers.

Adult↗
PubMed2003

Cytolytic vaginosis: examination of 2947 vaginal smears.

The aim of this study is to detect the rate of cytolytic vaginosis (CV) cases in patients with symptoms resembling those ones of candida vaginitis and to distinguish them from candidiasis cases by examining of 2947 Papanicolaou-stained vaginal smears. Fifty four of 2947 patients (1.83%) were diagnosed as having CV based on cytologic criteria such as naked nuclei of intermediate cells (IC), the overgrowth of lactobacilli, cytoplasmic fragmentations due to lysis of the cells. None of these smears contained candidal blastospores and hyphae and polymorphonuclear leucocytes. The pH was 3.5 to 5.5 and the clinical symptoms were profuse vaginal discharge (VD) especially whitish-cheesy vaginal discharge and other symptoms of vaginal candidiasis. The study indicated that special attention has to be paid during evaluation the vaginal smears of the patients with presumed vaginal candidiasis in order to prevent an erroneous diagnosis of CV.

Adolescent↗
PubMed2000

The interaction of trichomonas vaginalis with epithelial cells, polymorphonuclear leucocytes and erythrocytes on vaginal smears: light microscopic observation.

In this study, vaginal smears taken from 400 patients were examined cytologically using the Papanicolaou technique. Twenty of the 400 patients were detected as harbouring Trichomonas vaginalis. The interactions of T. vaginalis with epithelial cells, polymorphonuclear leucocytes (PMNLs) and erythrocytes were determined at light microscopic level. It was observed that T. vaginalis were juxtaposed to the epithelial cells and changed shape according to the contours of the epithelial cell revealing the cytopathic effect of trichomonads on epithelial cells. Trichomonads attached to PMNLs produced pseudopodia to phagocytose the cells. Occasionally an amoeboid shaped T. vaginalis organism was seen trailed by a row of PMNLs. This light microscopic study supports the production by trichomonads of a chemotactic factor for PMNLs. Phagocytosed erythrocytes were also seen in the cytoplasm of T. vaginalis, suggesting the need for the patient to be tested for anaemia.

Adolescent↗
PubMed1988

Oestrus and the vaginal smear cycle of the river otter, Lutra canadensis.

Vaginal smears of river otters contained specific cellular associations which can be used to monitor their reproductive cycle. The anoestrous period was identified by the presence of large intermediate epithelial cells while the onset of pro-oestrus was gradual and the duration difficult to determine. Oestrus was indicated by an influx of nucleated and non-nucleated cornified cells which continue after mating. The metoestrous smear was characterized by large quantities of leucocytes and mucus.

Animals↗
PubMed1986

[Eggs of Enterobius vermicularis in vaginal smears].

The technique of exfoliative cytology is used especially for early cancer diagnosis with cervical and vaginal smears. In these smears, some parasites eggs can be seen together with some kind of cells. One of these parasites is Enterobius vermicularis. Normally, this is intestinal parasite. But sometimes, especially in children, this parasite eggs can migrate in vagina by itching, and can cause vaginal discharge. The shape of egg is, one border is flat but the other is convex, and it may contain larva inside. We also observed the egg of Enterobius vermicularis which contains larva inside with squamous epithelial cells and polymorphonuclear leucocytes in a vaginal smear. As is seen, routine Papanicolaou smears are very useful to see unusual eggs of parasites during cancer detection.

Adult↗
PubMed2001

Frequency of Trichomonas vaginalis, Candida sp and Gardnerella vaginalis in cervical-vaginal smears in four different decades.

CONTEXT: Vaginitis is one of the principal motives that lead women to seek out an obstetrician or gynecologist. Bacterial vaginosis, candidiasis and trichomoniasis are responsible for 90% of the cases of infectious vaginitis. OBJECTIVE: To verify the frequency of the three main causative agents of vaginitis, Trichomonas vaginalis, Candida sp and Gardnerella vaginalis, in four different decades (1960's, 1970's, 1980's and 1990's). DESIGN: Retrospective. PLACE: A tertiary referral center. PARTICIPANTS: Patients attended to as gynecology and obstetrics outpatients at the Faculdade de Medicina do Triângulo Mineiro during the years 1968, 1978, 1988, 1998, taken as samples of each decade. MAIN MEASUREMENTS: Diagnoses of infection by Trichomonas vaginalis, Candida sp and Gardnerella vaginalis were gathered from 20,356 cervical-vaginal cytology tests on patients attended to as gynecology outpatients at Faculdade de Medicina do Triângulo Mineiro during the years 1968, 1978, 1988, 1998, representing the four decades. The results were grouped according to the age group of the patients: under 20, between 20 and 29, between 30 and 39, between 40 and 49, and 50 or over. Statistical analysis was done via the chi-squared (Mantel-Haentzel) test with a significance level of 5%. RESULTS: In 1968 infections by Trichomonas vaginalis and Candida sp were diagnosed in 10% and 0.5% of the cytology tests and in 1978, 5.1% and 17.3%, respectively (P < 0.0001). Infection by Gardnerella vaginalis could only be evaluated in the latter two decades. In 1988, 19.8% of the women had positive tests for Gardnerella vaginalis, which was the most frequent agent in that year, diminishing in the subsequent decade to 15.9% (P < 0.0001). Candidiasis was the most frequent infection in 1998, detected in 22.5% of the tests (P < 0.0001). In a general manner, all the infections were most frequent among younger patients, especially those aged under 20, in all decades, whereas infections were least frequent among patients aged 50 or over (P < 0.05). CONCLUSION: There was a reduction in the frequency of cervical-vaginal infection by Trichomonas vaginalis and an increase in the frequency of Candida sp over the four decades studied. All the infections were most frequent in patients aged under 20 years.

Adult↗
PubMed1991

Quantification of Candida albicans morphology in vaginal smears.

The morphology index (Mi) of Candida albicans cells was determined by microscopic image analysis in vaginal smears from 26 patients. The morphology of the cells typically showed a broad distribution of forms, but the mean Mi was greater than 2.0 in 23/26 instances, indicating a preponderance of pseudohyphal and hyphal forms. No association could be found between Mi and the clinical assessment of signs or symptoms of Candida infection. Comparison of these 26 patients with 43 others who had Candida-positive vaginal smears but with fewer than 15 fungal cells in the smear revealed significantly lower scores for vulvovaginal symptoms among the latter.

Candida albicans↗
PubMedDate not supplied

[Results of using the Bethesda system to evaluate vaginal smears. An end of Papanicolaou classification?].

Fifty three vaginal smears, classified to the III Papanicolaou group, were verified with Bethesda system. It was found that this system eliminates qualitatively erroneous preparations, increasing reliability of diagnosis, and facilitating precise description of cytological diagnosis. Advantages of Bethesda system justify its prompt introduction to the practice and abandon Papanicolaou classification.

Adult↗
PubMed1992

DNA cytometry in postirradiation cervical-vaginal smears.

Benign radiation change (BRC) in cervical-vaginal smears may be difficult to distinguish from postirradiation dysplasia (PRD) or recurrent cervical carcinoma. The utility of DNA analysis in postirradiation smears was evaluated retrospectively in 71 patients. Representative Papanicolaou smears were restained with a Feulgen method and 100 to 250 cells were analyzed for DNA content using the CAS 200 image analysis system. Thirty-three control irradiated patients had negative smears with a minimum 3-year follow-up. Thirty controls (91%) had diploid histograms with a mean coefficient of variation of 8.2% and an average of 6.8% of cells in S and G2/M phase. Three control patients had atypical nondiagnostic histograms. Twenty-three patients had abnormal smears and subsequent local recurrence; 21 (91%) had abnormal histograms, with seven showing polyploidy and 14 showing aneuploidy. The remaining 15 patients had abnormal smears diagnosed as PRD but no evidence of recurrent carcinoma. Five were polyploid, six were aneuploid, one was diploid, and three were atypical but nondiagnostic. Interactive DNA cytometry is useful in differentiating BRC from PRD and recurrent cancer. Aneuploidy is rarely, if ever, seen in negative smears with BRC. However, BRC may be associated with broad diploid peaks and increased proliferating cells. An abnormal histogram can be seen with PRD and does not always correlate with recurrent disease.

Adult↗
PubMed1987

Sequential radiation changes in cytology of vaginal smears in carcinoma of cervix uteri during radiotherapy.

The study deals with acute/immediate radiation changes in 2020 sequential vaginal smears in 101 patients of carcinoma of the cervix uteri, 97 were of squamous cell carcinoma and 4 of adenocarcinoma. The smears were collected after 12-14 days, 15-24 days and 25 days to 6 weeks following radiotherapy. The pretreatment vaginal smears were collected and examined for percentage of cancer cells. Subsequent smears were studied for radiation changes in benign and malignant cells, such as cell size, vacuolation of cytoplasm, multinucleation and nuclear changes, etc. A gradual and linear decline in cancer cells was observed until the end of therapy; 41.6% of patients had less than 10% cancer cells within 12-14 days of therapy, 63.4% of patients between 15 and 24 days and 74.6% after 25 days to 6 weeks following radiation. Eighty three percent of the patients attained zero level at the end of therapy.

Adenocarcinoma↗
PubMedDate not supplied

Acceptability of a self-sampling technique to collect vaginal smears for gram stain diagnosis of bacterial vaginosis.

To diagnose asymptomatic bacterial vaginosis (BV), self-sampled vaginal smears were collected during a study of risk factors for preterm birth in African American women. More than 90% of those women who were willing to participate in the interview portion of the study were also willing to provide a self-sampled vaginal smear. The smears are an acceptable and efficient way of detecting BV in an urban minority population.

Adult↗
PubMed2006

The International Infections in Pregnancy (IIP) study: variations in the prevalence of bacterial vaginosis and distribution of morphotypes in vaginal smears among pregnant women.

OBJECTIVE: The objective of the study was to determine the prevalence of bacterial vaginosis and the distribution of associated morphotypes among asymptomatic pregnant women in different countries. STUDY DESIGN: In 8 institutions participating in the Global Network for Perinatal and Reproductive Health (www.gnprh.org) from July 1999 to September 2001, 1466 women were enrolled. Vaginal smears were Gram stained and scored with Nugent's method at a reference laboratory. The prevalence of bacterial vaginosis and bacterial morphotype distributions were compared. RESULTS: Overall, 12.3% of women had bacterial vaginosis according to Nugent's criteria. Zimbabwe had the highest prevalence (24.4%) when compared with all other sites, except Myanmar (P < .05). Among bacterial vaginosis cases, 98.9% of vaginal smears had more than 30 Gardnerella/Bacteroides morphotypes present per oil immersion field. Individual centers showed significant differences in the number of Mobiluncus and lactobacillus morphotypes (P < .01). CONCLUSION: The prevalence of bacterial vaginosis and distribution of bacterial morphotypes in vaginal smears among asymptomatic pregnant women vary significantly in populations from different countries.

Actinomycetales Infections↗