Women with cervical cytological atypia and genital tract infection: Implications and management

Summary

Ninety-three women with atypical cervical smears attending the sexually transmitted diseases clinic were further investigated using various microbiological methods, cytology and colposcopy. The smear was defined as atypical when it was reported to show nuclear atypia of the epithelial cells not sufficiently pronounced to be termed dyskaryotic or cellular changes suggestive of human papillomavirus (HPV) infection. In addition, many of the smears contained numerous polymorphonuclear leucocytes. Microbiological studies revealed that 37 per cent of the patients were infected with microorganisms other than HPV. Chlamydia trachomatis was the pathogen most commonly detected, being present in 16 per cent of them. The repeat smear remained atypical in 45 per cent of the women and was more likely to remain so if there were cellular changes consistent with HPV infection. In contrast, persistent atypia were not influenced by the occurrence of the infections other than with HPV. Cervical intra-epithelial neoplasia was detected in 34 per cent of the patients and also did not correlate with the occurrence of infections other than with HPV. Nevertheless, we conclude that the management of patients with atypical cervical smears should include microbiological investigations because many have treatable infections.