Study About the Causative Agents of Cervical Infections and Cytopathological Changes in Iraqi Women

Abstract

Cervical infections are common problems among women, specially of reproductive age,  in Iraq ,and are one of numerous risk factors for cervical intraepithelial neoplasia and cervical cancer .

   The aim of this study was to investigate the causative agents of cervicitis and their association with cytopathological changes among 67 cases of women, aged from 16 to 60 years, who attended the  National Cancer Research Center / University of Baghdad, Iraq , during the period from April to December 2018  .

     The age group 36-40 had the highest percentage of cervical infections 13/16 (81.3%) while the age group 56-60 had the lowest percentage 2/6 (33.3%).

     Specific microbial inflammations were found in 51/67(76.1%) of the cases, as detected by microbiological examinations,   while 49/67(73.13%) were of non-specific inflammations. The main causative agent of cervical infections was Candida albicans: 36/67(53.7%) fallowed by : Neisseria gonorhoeae 5/67(7.5%) , enteric bacteria 6/67( 8.9%) and Trichomonas vaginalis 4/67(5.9%),.

      The cyto-diagnosis , as detected by using pap smears examination, revealed  some  cases 6/67(8.9%)  of suggestive of human papillomavirus HPV(Koilocytotic Atypia) with ASCUS (Atypical Squamous Cells of Undetermined Significance ) mixed with monillia infections and only two of these cases showed  CIN1 (Cervical Intraepithelial Neoplasia ) 2/67( 2.98%).

  The other cytopathological finding was atypical dysplasia of endocervical epithelial cell which showed in cases 18/36(50%) of monillia infections, 2/4(50%) of Trichomonas infections,3/6(50%) of enteric infections and in 4/5(80%) of Neisseria infections .While atypical Metaplasia found in cases 6/36(16.7%) of monillia infections ,1/6(16.7) of enteric infections and 1/5(20%) of Neisseria infections. There was only 1/36(2.8%) of AGUS (Atypical Glandular Cells of Undetermined Significance) found in case of monillia infections. Benign looking  of cervical cells , as resulted in pap smear tests , mostly found in cases of  Trichomonas infections 2/4(50%) , while showed in 2/6(33.3%)   of enteric infections and  in11/36(30.6%) of monillia infections. There were no benign looking cells of cervical in cases of Neisseria infections. Meanwhile, no women had adenocarcinoma according to Bethesda classification during this study.

   Although there was no incidence of cervical malignant cells seen in our study and only few cases showed CIN1(premalignant disease of the cervix), cytological screening should gain much popularity and should be accessible to all in order to prevent such serious  pathological problems.

 In Iraq, more attention should be paid for the important causation of cervicitis in women suffering from it because inflammatory and atypical changes on cervical cytology among women tested often indicate the presence of a sexually acquired infection.