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Abstract Five hundred successive pregnant women attending the antenatal clinic of Ilenha university ho s plt a I were screened clinically cytologically colposcopically and pathologically for evidence of specific infections and other pathological lesions in the lower genital tract. By cytological methods that included ; wet smear • methylene blue stained smear and Papanicolaou stained smear six types of specific infections of the lower genital tract were diagnosed. Candida albicans was detected in 140 cases ( 28%) Trichomonas vaginalis in 22 cases ( 4.4%) C n rd ne rc Ll a vaginal is in 95 cases ( 19%) Chlamydia trachomatis in 2 cases ( 0.4% ) herpes simplex virus in 4 cases ( 0.8% ) and condyloma accuminata in 9 cases ( 1.8% ). Clinical judgment alone was found to be unsatisfactory in diagnosing these specific infections of the lower genital tract. The simple cytologic methods used in this study could accurately identify the causative agent which is the basis for proper management of these infections. Methylene blue stained smears and wet smears were more reliable in the diagnosis of infections caused by candida albicans Gardnerella vaginal is and Trichomonas vaginalis than Papanicolaou stained smears • but. for the highest yield all three methods were indicated. These three types of infections constituted 94.5% of specific infections detected in this study. However Papanicolaou stained smears could diagnose infections caused by Chlamydia trachomatis herpes simplex virus and human papillomavirus ( condylomaL.-20iJaccuminata). less common Althoughas they those types of constituted only infections were 5.5% of cases with specific infections yet they are more hazardous to the mother and the foetus. Col po scopic examination revealed non-specific appearances in patients with infections caused by candida albicans Gardnerella vaginalis and c h I amydia trachomatis. Colposcopic examination revealed true erosion , which is characteristic of herpetic cervicitis, Moreover col po scopic herpes simplex virus examination revealed in only one infection. out of the 4 CDses with specific appearances namely double capillaries and colpitis macular is in 95% of cases with Trichomonas vaginalis infection. Also it revealed colposcopic appearances characteristic of condylomatous lesions in 8 cases out of 9 cases with cytologically condyloma accuminata. Moreover by the diagnosed aid of types flat condyloma ( 5 classified cases )colposcopy the into 3 distinct condylomatous lesions were exophytic condyloma colpitis ( 2 cases( 3) .cases )from the and condylomatous results mentioned above we can conclude that when diagnosis of specific infections of the lower genital tract is considered, cytology is superior to colposcopy. Pregnancy provides a suitable occasion for routine screening for cervical carcinoma. Routine cytology revealed dyskaryosis in 10 cases , only 8 of them proved to have CIN on pathological evaluation while the remaining 2 cases were chronic non-specific cervicitis. Routine colposcopy revealed abnormal colposcopic findings in 30 cases 25 cases inside the T. Z. and 5 cases outside the T.Z.. Pathological evaluation of colposcopically directed punch biopsies from these areas with abnormal colposcopic findings revealed CIN in 11 cases ( all inside T.Z.) acanthotic epithelium in 17 cases ( 13 inside T.Z. and 4 outside T.Z. ) and chronic non-specific cervicitis in 2 cases ( one inside T.Z. and one ouside T.Z. ). It was observed that cases with CIN were almost asymptomatic and 20 to 30 years. in 4 cases wi th 72.7% of them were in the age group Associated infections were encountered CIN as; T.V. in one case, HSV in one case, condyloma accuminata in 2 cases. Cytology showed a false-negative rate of 27.3% and a false-positive rate of 20%. Correlation between cytologic and colposcopic findings in the 11 cases with pathologically diagnosed CIN showed that cytology revealed dyskaryosis in only 8 cases while colposcopy revealed atypical transformation zone ( ATZ ) in 11 cases. So we think that as far as diagnosis of CIN is considered , colposcopy is superior to cytology. |