The natural history of vaginal intraepithelial neoplasia (VAIN) was studied in 23 patients followed for at least 3 years with no treatment. The mean age of the patients was 41 years of age. A large proportion of the VAIN lesions (50%) were multifocal, and approximately one half of the lesions were associated with concomitant cervical or vulvar intraepithelial neoplasia. Progression to invasive vaginal carcinoma occurred in two (9%) cases, persistence of VAIN occurred in three (13%) cases, and regression of VAIN occurred in 18 (78%) cases. The risk for progression to invasive carcinoma emphasizes the significance of colposcopic examination of the vagina with directed biopsy specimens obtained from all lesions.

The persistence of chlamydial immunoglobulin G (IgG) antibodies and long-term sequelae of pelvic inflammatory disease (PID) were studied in 70 women who had been treated for PID 3 to 6 years previously. Fifty-one women had had PID associated with Chlamydia trachomatis infection (Chlamydia group), and 19 women had had PID not associated with C. trachomatis (non-Chlamydia group). Chlamydial IgG antibodies, as determined by the indirect immunofluorescence test with inclusions of C. trachomatis L2 as antigens, persisted at stable levels in 43% of the women for up to 6 years; 43% of the women showed a decrease in IgG titer, and 13% showed an increase. IgA antibody levels in serum correlated with IgG antibody levels in serum and with the presence of cervical IgA antibodies. Both serum antibodies and cervical IgA antibodies were more often found in the Chlamydia group. Forty-two percent of the women were infertile. Every fifth subsequent pregnancy was ectopic. The presence of cervical IgA antibodies might protect the women from tubal damage.

The relevance of volatile fatty acids as a diagnostic test in 79 women with abnormal vaginal discharge was evaluated by a blind, randomised, and placebo controlled trial of tinidazole as a single oral 2 g dose. Automated gas chromatography of ether extracts of discharges taken before treatment showed volatile fatty acids in 18. Volatile fatty acids correlated with malodorous, colour, and microscopically assessed altered bacterial flora and clue cells. At follow up one week later, the odour, colour, and volatile fatty acids in the vaginal discharge of women treated with tinidazole had become normal more often than in those receiving placebo. The disappearance of volatile fatty acids correlated with clinically assessed improvement in women treated with tinidazole. The volatile fatty acid test as an indicator of anaerobic bacterial flora is objective, technically simple and fast, has few problems of sample size and transportation, and may be useful in the aetiological classification and follow up treatment of non-specific vaginal discharges.

Two murine monoclonal antibodies to carcinoembryonic antigen (CEA) were used to detect CEA by the immunoperoxidase staining method in mild dysplasia of the uterine cervix in order to evaluate the prognostic significance of the expression of this antigen. The high affinity antibodies (Ha) detected CEA determinants in 53% of the 47 lesions studied while 40% of the epithelial changes were positive with the low affinity antibodies (La). Ha antibodies stained ten out of the 16 progressive lesions (62%), while La antibodies detected CEA determinants in 38% of these. Forty-eight per cent of the 23 regressive lesions were CEA positive with Ha and 39% with La antibodies respectively. The eight persistent lesions expressed CEA equally frequently (50%) with both antibodies. The results indicate that tissue CEA in patients with mild cervical dysplasia does not reflect malignant potential.

Seventy-nine unselected women whose main symptom was abnormal vaginal discharge were seen at the Department of Obstetrics and Gynecology at Helsinki University Central Hospital between October 1980 and September 1981. All patients and their current sex partners were randomly treated either with a 2-gram single dose of tinidazole or with identical placebos. Those excluded were 9 patients who did not attend the follow-up examination, 15 who had specific cervicovaginal infections (6 with chlamydial infection, 4 with trichomoniasis and 5 with yeast infection), and 22 with normal Döderlein flora seen on vaginal Pap smear. Response to the treatment was analysed among the remaining 33 women, of whom 17 received tinidazole and 16 placebo. The symptoms and signs that best discriminated between those who had normal Döderlein flora and those who had non-Döderlein flora were malodour, other than white colour of the discharge, and the presence of clue cells on Pap smear. When these findings were used to evaluate the response to treatment, tinidazole proved to be more effective than placebo. Disappearance of clue cells best (p less than 0.01) discriminated between tinidazole and placebo.

Human leukocyte interferon cream was evaluated in a double blind placebo-controlled trial in 13 patients with widespread vaginal flat condylomatous dysplasia. Patients applied 12 million units of interferon vaginal cream daily into vagina during four two-week treatment courses separated by one-week intervals. Five of eight patients treated with interferon showed clear remissions in colposcopy. Cytologic examinations, however, revealed cells typical of condyloma in all cases. Two responding patients relapsed one and two months after the treatment. Among five patients using placebo, the lesions remained unchanged in three patients and progressed in two. Interferon treatment did not alter the microbiologic or cytologic picture of Papanicolaou smears, but lymphocytic infiltrations in the stroma next to condylomas were seen in histologic samples. No overt side effects were observed during interferon treatment.

The cytological abnormalities seen in connection with cervical inflammation due to Chlamydia trachomatis are briefly reviewed. Severe inflammatory changes and the occurrence of metaplastic cells and tissue repair cells, which are indicative of severe tissue damage, are common findings in chlamydial cervicitis. However, these changes may also be found in inflammatory states not caused by Chlamydia. Differentiation between the intracytoplasmic inclusions pathognomonic of chlamydial infection and the inflammatory degenerative cytoplasmic formations currently seen in exfoliated cervical cells cannot confidently be made from Papanicolaou-stained specimens. Routine cytology, therefore, is not the proper method for diagnosing chlamydial infection.

The use of IUDs can contribute to the incidence of actinomycosis. Actinomycosis formerly regarded as a fungal disease is now known to be caused by bacteria of the genus Actinomyces. The diagnosis of actinomycosis is difficult because the disease usually does not manifest itself in any specific symptoms. The most common diagnostic method uses histological slides. It is difficult to do cultures and they require good anaerobic techniques. Pap smears are usually reliable but not unambigous since in a heavy concentration of bacteria Actinomyces may be mistaken for similar organisms. More specific results can be obtained using immunofluorescence. Before 1973 actinomycosis was considered a rare disease a secondary one often resulting from an outbreak of appendicitis. Now it is commonly believed that women who have worn a plastic IUD for at least 2 years and possibly women whose copper IUDs have not been changed for some time are highly susceptible to actinomycosis. The 1st case of genital actinomycosis was discovered in 1973 with 10 cases reported in 1975 in which the patients had been using IUDs for at least 2 years. In 1979 2 deaths from genital actinomycosis were reported. Also in 1979 a study reported actinomycosis in 19% of 330 women using IUDs. 1980 study found the disease in 40 of 128 women using plastic IUDs and 2 out of 165 women using copper IUDs for over 2 years. In Finland physicians have always favored copper IUDs and frequent changes of any kind of IUD. A Swedish physician advocated in 1980 that all plastic IUDs be removed that copper IUDs be changed frequently and that no IUD be inserted if any gynecological infection is present. Annual pap smears are advisable and only where necessary antibiotics should be taken and IUDs removed. Actinomycosis can be cured with penicillin tetracyclines and erythromycin.

ABSTRACTCervical bacterial microflora was studied with a semiquantitative method in 29 women both before and after the termination of their pregnancy. The main findings were high prevalence of anaerobic bacteria (in 72%–79% of the specimens) consisting predominantly of Bacteroides species and anaerobic Gram‐positive cocci, and low prevalence of aerobic bacteria (in 24%–38% of the specimens). Among the other microbes studied, the prevalence of Chlamydia excretors was high (24%), probably reflecting a promiscuous study population. Seventeen percent of the women developed febrile postabortion endometritis or salpingitis. However, the cervical culture results predicted neither the patient prone to infection nor her response to antimicrobial treatment, suggesting the need for more data concerning the virulence properties of the bacteria, together with isolation of the organism from an infected site.

How is cervical dysplasia treated? There are many ways to treat cervical dysplasia (CIN). Factors influencing the choice of treatment for cervical dysplasia include the extent and severity of the dysplasia, the age of the woman, and whether or not she has any other gynecological problems. Often the experience of the physician or other clinician, and the availability of equipment are also major factors. The following are the most common methods of treating cervical dysplasia:

A study population of 240 young women who were sexual partners of men suffering from nongonococcal urethritis was investigated to establish whether it is possible, using routine cytology, to identify morphologic changed of diagnostic value in cervicitis due to Chlamydia trachomatis. Nonspecific severe inflammatory cellular atypias were significantly more frequent in the group of 93 C. trachomatis culture-positive women (38%) than in the control group of 147 C. trachomatis culture-negative women (18%). Tissue repair cells, appearing as a result of marked tissue destruction, were fond in 12% and in 3%, respectively. Intracytoplasmic inclusion bodies, pathognomonic of C. trachomatis, were not discovered in smears stained by papanicolaou's method. Hence, routine cytology is not the proper diagnostic method for chlamydial cervical infection. Dyskaryotic changes showing mild dysplasia occurred significantly more often in the C. trachomatis culture-positive women. This observation justifies the assumption that chlamydial infection may play a part in the development of dysplastic epithelial atypias of the cervix.

Of 177 gynecologic outpatients with cervical dysplasia studied, 29 (16%) were found to excrete Chlamydia trachomatis from their urogenital tract. Sera collected from 93 of these patients were significantly more often positive for and showed higher levels of antichlamydial micro-complement fixation (CF) and immunofluorescence (IF) antibodies than sera obtained from the controls. However, when the sera were tested for anti-herpesvirus type II (HSV-II) and cytomegalovirus (CMV) antibodies, no difference between the cases and the controls were encountered.

In a group of 59 patients over the age of 55 years with ovarian serous and mucinous cystadenomas, a total of 29 (49%) showed moderate or strong oestrogenic activity as determined by maturation index in vaginal cytologic smears, in contrast to nine (13%) of 70 control patients with other gynecological disorders than ovarian tumours. The bacterial flora was dominated by Döderlein type bacilli in 24 of the 27 test patients with an elevated maturation index, also reflecting the abnormal oestogenic activity in these patients. When the serous and mucinous cystadenoma groups were compared, a striking difference was found: of the 30 patients with mucinous cystadenomas, 23 (77%) displayed moderate of strong oestrogenic activity, while this was the case with only six (21%) of the 29 patients with serous cystadenomas. These findings stress the importance of an abnormal oestrogenic activity, revealed by an elevated cytologic maturation index, as memento for the possibility of post-menopausal ovarian cystadenoma.

Amoung 57,117 routinely collected Papanicolaou smears from the female genital tract there were 90 slides (0.16%) from 85 patients on which a cytologic diagnosis of herpes simplex virus (HSV) infection was made. The characteristic cytologic changes occurred predominantly on the ectocervical part of the smears. The changes were transient but occasionally remained detectable on the corresponding histologic specimens up to 2.5 months. Viral isolation was successful in a majority of cases when performed simultaneously with or less than a week after the cytologic diagnosis. The rate of success rapidly decreased thereafter. Positive fluorescent antibody assays of viral antigens on cytologic smears behaved similarly. Cases with apparent primary infection as well as with secondary infection (recurrences) were included in the material but no differences in the morphology of virally altered cells and be found, indicating that primary and secondary infections could not be distinguished on this basis. There were significantly more cytologic dysplastic changes as well as assorted micro-organism infections in the HSV group as compared to the controls.

A total of 244 pregnant women, 172 in the first and 72 in the third trimester, were screened for genital herpes simplex (HSV) and cytomegalovirus (CMV) infections using virus isolation, cytological examination and serological studies. In addition, immuno-fluorescence staining of exfoliated cervical cells was used for the detection of HSV infections. Herpes simplex virus (HSV) could not be isolated and no characteristic HSV altered cells were found in cytological (PAPA) smears. Cytomegalovirus was isolated four times but PAPA smears obtained from these patients were also normal. In 34 (14%) patients HSV antiserum detected immunofluorescence positive exfoliated cervical cells. Overall, 14% of patients had HSV-2 antibodies and 71% CMV antibodies. No differences between the first or third trimesters in these respects were noted.