Inflammatory cervical smears and infection in Kano, Northern Nigeria

Abstract

Background: Inflammation is commonly present in cervical smears for screening of pre-malignant lesions, so we undertook this study to identify microbial pathogens responsible for the inflammation. Method: This was a prospective study of cervical smears and endocervical swabs from patients at the gynaecology, postnatal and general outpatient clinics of Aminu Kano Teaching Hospital over a 4 month period. Results: A total of 421 women between the ages of 17 and 80 years were recruited for the study, but most (95%) were premenopausal (<50 years). Two hundred and thirteen (50.6%) of the smears were inflammatory as evidenced by prominent neutrophilic infiltrate, but only 127 (30%) of the study patients had infection as demonstrated by microbial growth on culture and positive Chlamydia antigen test. Sixty one percent (78 cases) of the 127 cervical infections occurred among the 213 patients with inflamed smears. The remaining 39% (49 cases) of cervical infections occurred in patients with non-inflammatory smears. Chlamydia and Candida were the most frequent microbes accounting for 68.5% of all cervical infections. Thirty nine (8.7%) of all smears were dysplastic with low grade dysplasia comprising the overwhelming majority – 35 cases. Conclusion: As in most published studies, cervical inflammation did not correlate with infection, as infection also commonly occurs in patients without inflammatory smears. This renders patient management problematic for gynaecologists. Further research is therefore required to clarify the microbial and non-microbial causes of cervico-vaginal inflammation.