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Herpes viral culture of a lesion is a laboratory test to check if a skin sore is infected with the herpes simplex virus. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
Colposcopy is an office-based technique designed to diagnose preclinical cervical neoplasia. CONTEMPORARY INDICATIONS FOR COLPOSCOPY Clinical practice guidelines published by the American College of Obstetricians and Gynecologists (ACOG)1 and the American Society of Colposcopy and Cervical Pathology (ASCCP)2 describe contemporary indications for colposcopy. We use cookies to ensure you get the best experience from our website.By using the website or clicking OK we will assume you are happy to receive all cookies from us. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. The technique was introduced into mainstream gynecology in the United States in the late 1960s.
In general, colposcopy is indicated as a response to an abnormal cytologic test and is appropriate for surveillance after treatment of CIN.
Shanxi Province Cervical Cancer Screening Study: a cross-sectional comparative trial of multiple techniques to detect cervical neoplasia. Immunological microenvironments in the human vagina and cervix: mediators of cellular immunity are concentrated in the cervical transformation zone. Colposcopic features of papillomaviral infection and premalignancy in the female lower genital tract. Vascular permeability factor (vascular endothelial growth factor) expression and angiogenesis in cervical neoplasia. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Muchas personas tienen diferentes factores desencadenantes de los brotes de herpes genital o labial. An improved colposcopic index for differentiating benign papillomaviral infections from high-grade cervical intraepithelial neoplasia. Al prestar atencion usted podra saber cual de estos factores como: exposicion al sol, el estres, o alimentos ricos arginina.
It was soon recognized that the earliest preinvasive conditions were not gross ulcerations or tumors but changes in the vascular pattern of the epithelial capillaries by the dense crowding of epithelial cell nuclei. Recommendations differ for women under age 21 years and pregnant women; separate tables are provided for these women. Son los causantes de su brote de herpes genital o labial2- Aprenda a reconocer los sintomas predominantes.
It is the vascular pattern and epithelial opacity that colposcopists now evaluate for evidence of preinvasive cervical lesions, also known as cervical intraepithelial neoplasia (CIN).
Todo el mundo va a un ritmo tan rapido que es facil pasar por alto las sustancias precursoras de un brote de herpes genital o labial.
Incluso si usted toma una dieta rica en arginina normalmente le aconsejo abstenerse de consumirla durante situaciones de estres  y asi reducira el riesgo de crisis provocada por arginina.
Todo lo que necesita Saber Infeccion Vaginal por Hongos o Herpes Genital ?Como identificarla? If normal at both 12 and 24 months, resume routine screeningAtypical squamous cells, cannot exclude HSIL (ASC-H) Colposcopy Low-grade SIL (LSIL)  Repeat cytology at 12 months (perform colposcopy if ASC-H or HSIL+) and at 24 months (perform colposcopy if ASC-US+).
When columnar epithelium extends onto the ectocervix, it appears as a red zone surrounding the os and is called ectropion or ectopy. Squamous epithelium, on the other hand, is smooth, pale pink in color, and consists of a stratified layer of up to 20–30 cells thick.
The junction between columnar and squamous cell types is called the squamocolumnar junction (SCJ), which in younger women is usually visible on the ectocervix. The colposcopic appearance of a normal squamous and columnar epithelium and the SCJ is shown in Fig.
The opened speculum has exposed the columnar epithelium surrounding the os and is in the endocervical canal. The overarching goal is to identify the highest grade of disease present in order to determine the need for and type of treatment. Most neoplastic changes are not visible to the naked eye but are visible under binocular magnification after application solution of 3–5% acetic acid.
These areas represent hyperkeratosis and can be associated with infection by HPV, chronic trauma or scarring.
It is generally recommended that biopsy of at least one representative area of leukoplakia be performed during a colposcopic examination. However, the acetowhitening of CIN is usually much more distinct than that of squamous metaplasia.
If the acetowhite epithelium extends into the cervical canal, an instrument called an endocervical speculum can be used to identify the extent of the lesion and to visualize the SCJ (Fig. The lesion on the anterior lip of the cervix exhibits large vessels running horizontal to the surface. The examination is unsatisfactory because the entire transformation zone cannot be see and the extent of the lesion is not known.


Although seen entirely, an excisional procedure rather than ablative is suggested due to the endocervical extension. Numerous scoring systems have been devised to assist the colposcopist in grading lesions based on these features.4, 5, 6 Attention to each of these qualities will assist the colposcopist to select the most significant abnormalities for biopsy. The appearance of borders and vascular patterns often can be enhanced by use of the green filter. Normal vessels are confined to the stroma below the epithelium and may be visible as a fine reticular pattern (Fig. The neoplastic tissue produces angiogenic factors such as vascular endothelial growth factor, which promotes the growth of new vessels (neovascularization).7 In CIN lesions, vessels can be found within the epithelium itself rather than confined to the area below the epithelium. Intraepithelial vessels that form loops towards the epithelial surface appear colposcopically as red spots on the surface of acetowhite epithelium. It can be either fine or coarse, depending of the size of the vessels within the fibrovascular core. As with punctation, mosaicism can be graded as fine or coarse depending on the diameter of the vessels. Atypical vessels typically have irregular enlarged caliber, form bizarre patterns and shapes such as spirals or commas, and do not follow the typical branching patterns described above.
The finding of atypical vessels warrants biopsy to determine whether invasive cancer is present.
Atypical vessels can also be more friable than normal vessels, hence areas of frank bleeding are suspicious for cancer. Therefore acetowhite lesions with a sharp well-demarcated border on all sides (360°) are more likely to be high-grade than are acetowhite lesions with indistinct borders.
Areas of squamous metaplasia can demonstrate diffuse, poorly defined borders because the process of maturation is a continuous process, and squamous metaplasia fuses with the normal squamous epithelium at the distal margin.
In general, the sharper and smoother the border, the more likely it is that a high grade lesion is present. In areas of invasive carcinoma, the surface contour may be grossly uneven with raised nodular areas or exophytic growth.
An area of frank ulceration is also suggestive of invasive cancer and is termed erosion (Fig. Squamous metaplasia is usually a more opaque white than the thicker white of a high grade CIN lesion. Cervical warts are usually a bright pure white color compared to the gray or yellowish tones of invasive cancer. High-grade CIN lesions have low amounts of glycogen because the epithelium is poorly differentiated, and hence they do not turn brown with Lugol’s solution. When bacterial vaginosis, trichomoniasis, or candidiasis is present, there is often considerable discharge, as well as some hyperemia that may make evaluation of the cervix difficult (Fig. Trichomoniasis may cause dilated capillary loops (strawberry spots) that can be interpreted as coarse mosaicism (Fig. If possible, cervicovaginitis should be treated before colposcopy is performed.COLPOSCOPIC TECHNIQUE Colposcope OVERALL DESIGN The colposcope is a steroscopic microscope with a long focal length (typically 30 cm) in order to be able to focus on the cervix. If the focal length is not long enough, the colposcope will be in the way of biopsy instruments. Coarse focus is achieved by changing the distance between the eyepiece and the patient, either by moving the entire instrument itself or by moving the flexible arm.
Fine focus is available on some instruments with a handle or a knob that moves the eyepieces only. All colposcopes should be fitted with a red-free (green) filter that can be swung in front of the light source. The green filter reduces the amount of illumination minimally while enhancing the contrast of acetowhite epithelium and vascular patterns. Ideally the colposcope will have at least three magnification lenses that span from low to high magnification. Adjustment of the interpupillary distance is essential to achieve binocular depth perception.
In addition, on most colposcopes one or both eyepieces have diopter settings to adjust focus for each eye individually.
This requires a beam-splitter to send the image to both the eyepiece and the camera, a videoscreen, and a computer with appropriate software for image capture and data management. With such a setup, it is possible to record the examination, to use the monitor for teaching, and to demonstrate the findings to the patient. If an adjustable examination table is not available, an adjustable chair is the next best option. Ideally the chair and exam table height are optimally aligned to visualize and illuminate the cervix while allowing comfortable examiner posture. A condom placed over the speculum can also sometimes achieve the goal of retracting the vaginal sidewalls. It has narrow blades that can be inserted into the endocervical canal and retracted in order to widen the diameter of the external os (Figs.
The instrument should have sharp cutting edges (including straight- or toothed-edge versions) rather than one cutting edge and one smooth edge.


Instruments should be handled with care to avoid misalignment and dulling of the cutting surfaces.
Lugol’s is a strong iodine solution that stains normal epithelium dark brown, useful for delineating normal from abnormal epithelium, for defining the borders of a lesion, and for finding vaginal lesions.
These provide a useful cautery agent that is applied with pressure to bleeding biopsy sites.
It is caustic, more effective than silver nitrate, and stings, hence it is important to apply it focally to the bleeding site and to avoid vaginal sidewalls and external genitalia.
Large swabs are useful for applying solutions to the cervix, for manipulating the cervix and vaginal fornices to optimize visualization, and for applying pressure for hemostasis.Small cotton swabs. Due to the small size of the samples, small specimen containers are advisable.Spatula and endocervical brushes if cervical cytology is to be collected at the time of colposcopy. After thorough inspection, 3–5% acetic acid is applied to the cervix with a saturated large swab, using pressure rather than rubbing to avoid denuding the surface epithelium.
Repeated application of acetic acid during the course of the examination is necessary as the acetowhite changes can fade within 1–2 minutes after application. The endocervical canal can be visualized with the assistance of the endocervical speculum or small cotton swabs used to retract the edges of the external os. Any areas of acetowhite epithelium should be examined using the criteria described above and the most abnormal areas should be sampled with a biopsy. Injection of anesthetic is unnecessary for cervical biopsy due to low density of nerve endings sensing pain.
Sharp instruments reduce the pain associated with biopsies; hence it is important to maintain the equipment in good condition and to send for sharpening when necessary. For a large lesion, the biopsy should be taken closest to the squamocolumnar junction, since the highest grade of disease is usually the most proximal. Depending on the extent and appearance of the lesion(s), several biopsies may be necessary. The biopsy sample should be placed immediately in formalin and labeled with the patient identifiers and location. It is always necessary to take a sample of the epithelium and underlying stroma to be able to accurately grade the dysplasia and to rule out invasive cancer. Pressure with a large swab or cautery with silver nitrate or Monsel’s solution can be used to control bleeding after biopsy.
This technique uses a small curette to obtain a circumferential scraping of the endocervical epithelium. Tissue captured on the curette should be collected by rinsing the instrument directly into formalin (avoid the use of telfa as loss of tissue due to sticking to the telfa may lead to an insufficient sample). Additional tissue should be recovered from the canal with an endocervical brush passed into the canal and rotated at least twice, then scraped off the brush into the formalin bottle. In cases in which a stenotic os does not admit the curette, a suitable sample may be obtained with aggressive use of a series of endocervical brushes. Table 4 outlines management strategies after initial colposcopy generally based on current ACOG and ASCCP guidelines.
If HSIL interpretation upheld, may perform either DEP (nonpregnant women only) or colposcopy and cytology at 6 and 12 months  Unsatisfactory colposcopy. Biopsies of suspicious lesions may be obtained, but bleeding may be more brisk than in the nonpregnant state. The examiner is advised to hold a cotton-tipped swab next to the end of the biopsy instrument and place the swab immediately into the biopsy crater. Another swab containing Monsel's solution can then be exchanged in the biopsy location.
ASCCP guidelines state that repeat colposcopic and cytologic examination to rule out progression to invasive cancer is acceptable but should not be performed more frequently than every 12 weeks.
Because the vulvar skin is keratinized, acetic acid only slowly produces acetowhite changes. Soaking a gauze sponge in acetic acid and holding it against the vulva for a minute is an effective method for applying acetic acid. Acetowhite changes may be associated with VIN, HPV, and hyperkeratotic areas due to trauma, scratching, or pressure. A local anesthetic, such as lidocaine, should be injected into the epithelium with a 30-gauge needle and a specimen including both epithelium and stroma obtained.
On the labia minora and vestibular area, a cervical biopsy punch can be used to obtain a biopsy.
Usually the application of silver nitrate to the base of vulvar biopsy sites is all that is necessary to stop bleeding. A biopsy should be performed on any lesion that shows change in pigmentation particularly areas with irregular edges and contours. For more information, the reader is referred to the chapter on chapter on Vulvar intraepithelial neoplasia.



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