International Journal of Gynecology and Obstetrics 81 (2003) 69–70
Cytologic, colposcopic, and virologic detection of cervical herpes simplex virus A.M. Elnashara,*, A. Aboeleab, T.A. Tantawyc a
Department of Obstetrics and Gynecology, Benha University, Benha, Egypt b Department of Microbiology, Benha University, Benha, Egypt c Virus isolation section, NAMRU-3, Cairo, Egypt
Received 8 January 2002; received in revised form 22 November 2002; accepted 27 November 2002 Keywords: Cervical Herpes simplex virus; Papanicolaou smear; Direct fluorescence antibody stain; Culture; Colposcopy
Studies on cervical herpes simplex virus (HSV) in Egypt are scant. The clinical symptoms of genital herpes are a poor indicator of infection w1x. The exact prevalence of genital herpes is unknown because not all patients with active infections seek medical care, and because the proportion of asymptomatic disease is high w2x. The principal site of HSV infection in the female is the cervix. Initial genital infection involves the cervix in more than 80% of cases, and both the ectocervix and the endocervix may be involved. Herpes infection of the lower genital tract has been associated with cervical cancer, although a causative role remains unproven. Several adverse outcomes of pregnancies complicated by gestational HSV infections have been described. These include spontaneous abortion, prematurity, intrauterine growth retardation, congenital infection, and neonatal infection w3x. The objectives of this study were: (1) to determine the isolation rate of cervical HSV in relation to different clinical conditions and colposcopic findings; and (2), to determine the sensitivity *Corresponding author. Tel.: q20-50-221-8161; fax: q2050-233-1911.
and specificity of the Papanicolaou (Pap) smear, direct fluorescence antibody (DFA) stain, and tissue culture in patients attending the outpatient clinic of Benha University Hospital. This study included 250 patients. For each patient a Pap smear and two endocervical scrapings were obtained, one for staining with DFA and the other for HSV-2 isolation on a monolayer of Buffalo Green Monkey kidney cell culture. Colposcopy was performed in all patients. A punch biopsy was taken in cases suggestive of squamous intraepithelial lesion. Of the 250 patients, 36 (14.4%) tested positive for HSV by culture on BCM cells, 29 (11.6%) by DFA staining, and 16 (6.4%) by Pap smear. DFA had higher sensitivity (58.3% vs. 31.3%) and negative predictive value (93.2% vs. 89.7%) than the Pap smear. The virus isolation rate was not significantly higher in the multigravida, multipara patients with a history of two or more abortions, pregnant women, women using contraceptive pills or intrauterine contraceptive devices, or women with an atypical transformation zone. The isolation rate of cervical HSV was 14.4% in the women attending the outpatient clinic of
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A.M. Elnashar et al. / International Journal of Gynecology and Obstetrics 81 (2003) 69–70
Table 1 Isolation rate of HSV using a BGM culture compared with colposcopic findings Z
Colposcopic findings No. Typical transformation zone (TTZ) Ectopy Infected typical transformation zone Atypical transformation zone (ATZ) Total
Positive BGM culture
19 (20.7%) 11 (23.4%)
3.12* 3.11† 58‡
-0.05 -0.05 )0.05
*EctopyyTTZ; †infected TTZyTTZ; ‡ATZyTT.
Benha University Hospital. The Pap smear is not useful in the detection of HSV. The virus isolation rate was significantly higher in women between 20 and 30 years of age, in women with a history of herpetic-like lesions on the genitalia, in women with cervical ectopy, and in women with infected typical transformation zone (Table 1).
References w1x Corey L, Spear P. Infections with herpes simplex virus. N Engl J Med 1986;314:686 –691. w2x Ryan K, Berkowitz R, Barbieri R. Genital herpes. Kistner’s gynecology. New York, NY: Mosby, 1995. p. 506 –509. w3x Prober C, Arvin A. Genital herpes and the pregnant woman. Curr Clin Top Inf Dis 1989;10:1 –6.