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admin | What Cures Bv | 01.03.2014
Cervical cytological changes in HIV-infected patients attending care and treatment clinic at Muhimbili National Hospital, Dar es Salaam, Tanzania. BACKGROUND: Tanzania is among Sub-Saharan countries mostly affected by the HIV and AIDS pandemic, females being more vulnerable than males.
Department of Pathology, Muhimbili University of Health and Allied Sciences (MUHAS), P,O, Box 65001, Dar es Salaam, Tanzania.
Cancer of the uterine cervix remains the second commonest cancer among women worldwide [1], more than 85% of the global burden of this disease occurs in the developing world [1] being the commonest malignancy in women in Sub-Saharan Africa according to Globocan 2008 (IARC) [2]. This was a prospective unmatched, case-control study of HIV-seropositive, ? 18 years of age and consenting non-pregnant patients attending the care and treatment center (CTC) for highly active antiretroviral therapy (HAART) at MNH as cases was done between 2005 and 2006.
The smears were fixed in cold acetone at 4°C for 10 minutes and dried at room temperature (RT) for 10 minutes.
Negative controls included sections which did not express the antigen under study and TBS instead of the primary antibody. The smears were finally evaluated in a Carl Zeiss Axiomatic microscope (Jena, Germany) and digital microphotography was done using an Olympus Camera Model DP 12 (Olympus Corporation, Japan) and pictures processed using Adobe Photoshop 7.0 (Adobe Systems Incorporated, San Jose, USA). Patients' identification, biodata and experimental results were entered in structured and computer coded questionnaires. A total of 170 women were recruited from the two centers (120 HIV-seropositive cases on HAART from MNH and 50 seronegative controls from ORCI) between 2005 and 2006.
This was performed on cell blocks and smears from the cervix fixed in cold acetone for 13 cases of LSIL, 7 cases of HSIL and 4 cases of carcinoma with cytomorphological features suggestive of HPV infection. The increased frequency of cervical lesions generally among adults in this study contrasted those of a previous study reporting a peak among adolescents and young adults [17]. In the present study the frequency of cervicitis among HIV infected patients appears higher compared to a US study where it was reported to be 15% [18].
That the HIV seropositive patients on HAART (cases) were more likely to have SIL and invasive carcinoma of the cervix than their corresponding controls seems in part, to be related the increased risk behavior for STI including HPV, HSV and in fact HIV among this group as depicted by marital status (singles), number of lifetime sexual partners (multiple) and an early age at first sexual intercourse [21-23]. Due to limitations in resources, the isolation of Chlamydia in cell culture as well as the use of monoclonal antibody to detect Chlamydia elementary bodies could not be achieved in the current study.
Squamous cell carcinoma was the most predominant type of cancer found among HIV infected patients which would be consistent with a concurrent HPV infection as suggested in our results and would be in agreement with a previous report indicating that HIV alters the natural history of HPV infection, with decreased regression rates and more rapid progression to high grade and invasive lesions, which are refractory to treatment, requiring more stringent intervention and monitoring [5]. The relationship between high parity, OC use and cervical cancer has been suggested and is probably attributed to hormonal factors [29,32]. Loss of wild-type p53 activity is an important event in neoplastic transformation in cervical squamous epithelium and is thought to occur by its degradation by the E6 viral protein of HPV 16 and HPV 18 [33]. The cytological findings in this study suggest that the frequency of SIL and carcinoma appeared to be higher among HIV-infected women on HAART compared to seronegative controls and as expected increased with age. LMM conceived the study, collected tissue specimen, clinical records, and performed the staining, data analysis as well as contributed to manuscript writing.
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This infection is easily curable with bacterial vaginosis treatment and can be cleared up in just a matter of days with a course of antibiotics, such as Metronidazole.
Bacterial vaginosis (BV) is a common condition affecting women, in which the balance of bacteria in the vagina becomes disrupted. It is highly possible that you could be infected with bacterial vaginosis and not realise it because it is often asymptomatic. Bacterial vaginosis is a very common infection, and estimates suggest it will affect one in three women at some point in their lives.
Currently there aren't any home remedies or natural cures available for the treatment of bacterial vaginosis; therefore antibiotic treatments are the only effective option when treating this infection. Located below are some tips that can be followed to successfully prevent bacterial vaginosis (BV). Bacterial vaginosis (BV) is a highly common vaginal infection, affecting many women in the UK.
If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus. HIV infected women appear to have a higher rate of persistent infection by high risk types of human papillomavirus (HPV) strongly associated with high-grade squamous intraepithelial lesions (HSIL) and invasive cervical carcinoma.
The introduction of the Papanicolaou (Pap) smear in 1930's made early detection and treatment of pre-invasive disease possible, which has significantly reduced morbidity and mortality related to cervical cancer in developed but not developing countries, due to the absence of effective screening programs [3]. Smears were then dehydrated in ascending graded alcohol from 70% to 95% and stained with orange G for 3 minutes, rinsed in 95% alcohol followed by staining with EA 36 for three minutes and then dehydrated in absolute alcohol. After Tris-Buffered Saline (TBS) rehydration, blocking of endogenous peroxidase activity with hydrogen peroxide (H2O2) was done for 30 minutes at RT. Five microns (5 ?) thick sections were placed in xylene over night for deparafinization, and hydrated in descending grades of ethanol to distilled water.


The expression of p53 was absent in the tested slides compared with the colorectal carcinoma used as positive control, in which the expression of p53 was strong and nuclear in location. However, the discrepancy in the results could be due to selection bias considering that all our patients were recruited from the CTC, which is mainly attended by patients older than 25 years on ART and hence not representative of the general population.
The difference may be due to the higher prevalence of HIV and AIDS in sub-Saharan Africa (including Tanzania) compared to USA [19,20].
A previous study showed that inflammatory changes on cervical cytological smears often indicate the presence of STI and masked underlying premalignant disease of the cervix [24]. Nevertheless, our index study indicated that features suggestive of Chlamydia cervicitis were more common among HIV infected patients, which corroborates with several previous reports in which researchers reported that the highest prevalence of Chlamydia trachomatis (CT) there was found in HIV infected individuals [25,26]. However, a previous report suggested a high frequency of adenocarcinoma amongst HIV-infected patients [29] and epidemiological and sample population differences may explain the discrepancy. On the basis of these mechanisms, clinically relevant p53 immunoreactivity would not be expected in HPV related cervical carcinoma and SIL and this is shown in our current study which also concurs with previous reports suggesting that the expression of p53 is decreased in lesions infected with intermediate and high risk HPV due to the differential ability of HPV E6 proteins to bind to and degrade p53 [33,34].
HIV seropositive patients appeared to present earlier with SIL compared to those HIV seronegative suggesting a role of HIV in altering the natural history of HPV infection and cervical lesions. ARM conceived the study, supervised proposal write-up, taught, performed and supervised the staining, performed microphotography, supervised data analysis, wrote the manuscript, corresponded with editors and publishers and effected all reviewers' and editorial corrections. Histograms showing the distribution of patients according to marital status and HIV infection. This Histogram shows that squamous cell carcinoma (SCC) as well as squamous intraepithelial lesions (SIL) were more common amongst HIV seropositive women.
A micrograph showing Pap staining showing abundant clue cells (arrow) suggestive of bacteria vaginosis more likely due to Gardnerella vaginalis infection (? 40).
Pap staining in a patient with acute cervicitis showing a squamous cell with cytopathic changes characterized by the presence of a cytoplasmic inclusion body (arrow and inset) indicating Chlamydia infection (? 40).
Pap staining in a patient with LSIL showing extensive leukocytic background and a binucleated parabasal squamous cell with mild nuclear enlargement and fine granular chromatin (arrow and inset) suggestive of viral (HPV) or TV infection (? 100). Pap staining in a patient with HSIL showing abundant neutrophils, a cluster of dendritic cells. Pap staining in a patient with squamous carcinoma which exhibits clusters of cohesive cells with marked nuclear enlargement, pleomorphisms, hyperchromatism and keratinization (? 40).
In fact, this infection is the most common form of vaginal infection that can affect women in the UK. This fast-acting, highly effective and clinically proven bacterial vaginosis treatment can be ordered here at OnlineClinic today.
It can treat bacterial sexually transmitted infections, including bacterial vaginosis and trichomonas vaginalis. This can often cause vaginal discharge; in fact, bacterial vaginosis is currently the most common cause of vaginal discharge in the western world, with over 100,000 new cases each year in the UK. This is because the infection occurs internally within your vagina, rather than externally. Though this STI is most commonly found in women who are sexually active, the infection is not necessarily spread through sexual intercourse. The common lack of symptoms often means the infected woman is unaware that this is the case. Taking an effective antibiotic treatment can successfully treat this infection and avoid conditions caused by bacterial vaginosis, such as the risk of contracting further STIs, including HIV.
You can find out more about cookies and manage your preferences by following the link below. HIV-infected women have a higher likelihood of developing persistent high-risk human papillomavirus (HPV) infection, precancer [high-grade squamous intraepithelial lesions (HSIL)], and invasive cervical cancer than seronegative women but this has not been clearly documented in Tanzania [1,4]. Thus all women meeting these criteria at the two centres during the study period were included the sample prospectively.
Thereafter the smears were placed in xylene to remove alcohol and finally were mounted with DPX and glass cover slips were applied. Antigen retrieval was achieved by heating sections to boiling in Citrate Buffer at pH 6.0 in a microwave oven for 10 minutes and sections then allowed to cool to RT. In this study 9.4% of smears of HIV infected patients with cervicitis showed some cells with cytoplasmic inclusions, suggesting Chlamydia infection (Figure 4). These results suggest the ability of HPV oncogenes (like E6) to interact with p53 although the samples tested were few.
However, both the current and the previous studies report increasing frequency of amongst those aged ? 56 years as expected [29].
Thus the frequency, distribution, risk factors and pathogenesis of cervical lesions amongst a selected cohort of Tanzanian women, have been further elucidated by our current study. The absence of p53 immunoreactivity in HPV + lesions is indicative of the ability of HPV E6 proteins to interact with the tumor suppressor gene and pave way for viral-induced oncogenesis in the studied Tanzanian women.
HAM conceived the study, supervised proposal write-up and data analysis and corrected the manuscript.


The arrows show a parabasal squamous cell with multiple cytoplasmic vacuolation suggestive of viral infection (? 40). The high dosage makes Metronidazole a fast acting treatment that is clinically proven to be safe as well as effective. The most common symptom you will likely notice if you do experience symptoms is a change to your normal vaginal discharge. What causes the imbalance that leads to bacterial vaginosis is not yet definitively understood, but factors that can increase the risk of developing the infection include certain antibiotics, smoking, using intrauterine devices and vaginal douching.
Complications can arise if the infection remains untreated for a length of time, most notably an increase in the risk of contracting further STIs, including HIV. The most effective antibiotic to cure BV is Metronidazole, which is able to prevent the ability of the bacteria to spread in your body. Other complications can potentially include pelvic inflammatory disease and problems during pregnancy. Furthermore, HIV-associated cervical lesions are multicentric, aggressive and recurrent after treatment [5]. The excess NHS was wiped off and slides incubated over night at 4°C with primary antibodies [mouse monoclonal anti-human p53 (clone DO-7) (Dako, Glostrup, Denmark)]. Furthermore, follicular cervicitis was identified in two conventional smears of HIV infected patients. However, a previous study reported that some Chlamydia negative patients had a Pap test which was reported to contain inclusions consistent with Chlamydia infection [27].
EEK conceived and supervised the study, procured reagents, taught and supervised the staining and corrected the manuscript.
We are also grateful to the Heads and members of the Departments of Pathology (MUHAS) as well as Laboratory Services (MNH) where the study was conducted.
It is possible for this to happen when sexual activity has not occurred, but it is more common in sexually active women.
Other risks include complications during pregnancy and the development of pelvic inflammatory disease.
The treatment we have available to successfully bacterial vaginosis and prevent any further complications is called Metronidazole. Co-infection with HPV and HIV is to be expected and recent epidemiological data from Africa show that cervical cancer is the most common AIDS defining neoplasm in women [5]. HIV infected women with cervical cancer before the age 35 years is considered an acquired AIDS-defining illness by the Centers for Diseases Control (CDC) [5,30,31]. It can be spread when two individuals engage in unprotected sex, whether this is vaginal, anal or oral.
Metronidazole is usually prescribed in a 400mg dosage to be taken twice a day for one week. This high dosage prescription medication is clinically proven to quickly and effectively treat bacterial vaginosis, as well as Trichomoniasis (a parasitic STI). The same applied to the association of SIL and cervical cancer with marital status, number of sexual partners and increased parity but not with the use of oral contraceptives (OC) were majority of cases and controls with the conditions were non-OC users. Furthermore, follicular cervicitis (FC) also identified in this study is reported to be associated with CT infection [28]. On this page we will be looking discover the facts about bacterial vaginosis to help those currently dealing with this condition. You can buy Metronidazole 400mg tablets at OnlineClinic after completing a simple online consultation. Unlike other AIDS defining neoplasms, the occurrence of cervical cancer is not dependent on immune compromise [5].
The distribution of cytological features suggestive of HPV infection (koilocytosis) between cases and controls was not statistically significant (P-value = 0.76).
It is established that invasive cervical cancer is the end result of progressive changes, beginning with precursor lesions namely cervical dysplasia or cervical intraepithelial neoplasia (CIN) also called squamous intraepithelial lesion (SIL), carcinoma in-situ (CIS) and lastly invasive carcinoma [7]. However, if early detection is made, pre-malignant lesions are reversible and cure of early-stage cancer is achievable. A number of risk factors that contribute to the development of cervical cancer, including low socioeconomic class, sexual intercourse at an early age, multiple sexual partners, multiparity, long-term oral contraceptive use, tobacco smoking, vitamin deficiency and sexually transmitted infection (STI) including Chlamydia trachomatis and Herpes virus type II have been identified [8-10] including the human papilloma virus (HPV) as a primary sexually transmitted etiologic agent in the development of cervical squamous cell carcinoma (CSCC) and its precursors [11].
Furthermore, HIV-related immunosuppression seems to contribute to increased frequency of SIL and HSIL as previously reported from Tanzania although that study did not include invasive cancer [12]. HIV infection and cervical cancer are major public health problems among women in Tanzania, although, the frequency of cervical cancer and pre-cancerous lesions in the general compared to the HIV-infected populations in Tanzania is not well documented and is elucidated in the current study.



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