TITLE:
Asymptomatic Bacterial Vaginosis in Cervical Cytology: A Preliminary Report of Incidental Finding in Routine Cervical Cancer Screening
AUTHORS:
Fausta Chioma Jacinta Emegoakor, Okechukwu Charles Okafor, Omosivie Monica Ugwu, Ebele Vivien Okolie, Chinyere Molokwu, Chinonyelu Orji, Olive Obienu
KEYWORDS:
Asymptomatic Bacterial Vaginosis, Pap Smear, Cervical Cytology
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.10 No.10,
October
28,
2020
ABSTRACT: Background: Bacterial vaginosis
is a complex pathogenic group of bacteria which can cause a wide range of
symptoms in affected women in Obstetric and Gynaecological practice. Its
occurrence usually indicates alteration in the normal vaginal flora expected in
majority of the women of reproductive age. Amongst the maintenance agents of
the vaginal health, lactobacilli occupy a prominent place. Asymptomatic
bacterial vaginosis is postulated to be linked to the development of cervical
intraepithelial neoplasia by some researchers while some differ in this regard. Objective: To determine the rate of occurrence of asymptomatic bacterial
vaginosis and associated factors in women who underwent cervical cytology for
cervical cancer screening. Study Design: A cross sectional study
involving microscopic examination of cervical smears of eligible clients
presenting for routine Pap smear. Setting: The study was carried out in
a well woman’s facility established and manned by female medical doctors in
Enugu state with the assistance of trained nursing staff. Various female
cancers and other communicable and non-communicable disease screening are performed at the centre. The services
are available to the general public including various parts of the state and
other nearby states. Methods: This preliminary study was carried out on
women presenting for cervical cancer screening between February and July 2018
in a well woman’s centre in Enugu. Information on the socio-demographic and
gynaecological history of the study participants were obtained and recorded in
designated proformas. Smears that showed changes suggestive of bacterial
vaginosis on microscopy were set aside for further evaluation. Such changes
included: a conspicuous absence of normal flora of lactobacilli; filmy
background of coccobacilli replacing the lactobacilli, individual squamous
cells covered by a layer of bacteria (clue cells); viable squamous cells
showing reactive changes identified as increased nuclear size, perinuclear halo
and binucleation. Data entry and analysis were done using statistical package
for social sciences (SPSS) computer software version 21.0. Results: 285
eligible women had cervical smear done during the first six months of the 2-year project at the
centre. 50.9% were above reproductive age (>45 years), 38.2% were in second half of reproductive
age (31 - 45), 10.9% were in the
early reproductive age (15 - 30). 13% of the women were
nulliparous, 51.9% were para 1 - 4, and 35.1% were grand multiparous. Of the 285 Pap smear slides viewed, 31
had bacterial vaginosis by the above criteria. This gave a prevalence of 10.8% in the
reviewed cytological smears. There was an association of bacterial vaginosis
with reproductive age. There was however, no association with age at coitarche
and parity. There was also, no association of bacterial vaginosis with
contraceptive use. There was no association between abnormal cervical cytology
and asymptomatic bacterial vaginosis with absent lactobacilli. Conclusion: Prevalence of bacterial vaginosis is significant in our study population who were asymptomatic.
Cervical smear should be taken advantage of as a tool for both cervical
pre-cancer and bacterial vaginosis screenings since same sample can
simultaneously be used for both conditions during cytology. Bacterial vaginosis may be unlikely
involved in pathogenesis of cervical intraepithelial neoplasia. Recommendation: Researchers
should harmonise the standards/criteria for the diagnosis of bacterial vaginosis because there
are varied criteria for the diagnosis in the literature. Given, the dual
advantage of pap smear in diagnosing cervical pre cancer stages and infections,
more elaborate studies are needed to determine the usefulness of treatment or
otherwise of bacterial vaginosis which constitutes significant incidental findings.