From the Guidelines
The Pap smear result indicates a normal cytology with no evidence of precancerous or cancerous cells, but shows a predominance of coccobacilli bacteria suggesting bacterial vaginosis (BV), and treatment is recommended if symptoms are present. This represents a shift in the normal vaginal flora from lactobacilli to anaerobic bacteria. According to the 2018 update by the Infectious Diseases Society of America and the American Society for Microbiology 1, the diagnosis of BV can be made using clinical criteria, such as the Amsel diagnostic criteria, or a scored Gram stain of vaginal discharge.
Key Points to Consider
- The standard treatment for BV is metronidazole 500mg orally twice daily for 7 days, or metronidazole gel 0.75% intravaginally once daily for 5 days, or clindamycin cream 2% intravaginally at bedtime for 7 days.
- Even without symptoms, treatment may be considered to restore normal flora.
- BV occurs when the vaginal environment becomes less acidic, allowing overgrowth of certain bacteria.
- After treatment, maintaining vaginal health through proper hygiene, avoiding douches, and possibly using probiotics may help prevent recurrence.
- No follow-up Pap testing is needed earlier than routine screening since the cytology was normal, as stated in the 2021 sexually transmitted infections treatment guidelines 1.
Management of BV
The management of BV involves treating the infection and restoring the normal vaginal flora. This can be achieved through the use of antibiotics, such as metronidazole or clindamycin, and maintaining good vaginal hygiene.
Prevention of Recurrence
To prevent recurrence of BV, it is essential to maintain good vaginal hygiene, avoid douching, and consider using probiotics. Additionally, treating any underlying conditions that may be contributing to the development of BV, such as diabetes or immunosuppression, can help prevent recurrence.
From the Research
Pap Test Results
- The result "NEGATIVE FOR INTRAEPITHELIAL LESION OR MALIGNANCY" indicates that no abnormal cell changes were found in the Pap test sample 2, 3.
- A predominance of coccobacilli consistent with a shift in vaginal flora may be related to aerobic vaginitis, which has been found to be common in women with low-grade squamous intraepithelial lesions (LSIL) 4.
Cytological Correlation
- The correlation between Pap test results and histopathological findings is crucial for accurate diagnosis and treatment 2, 5.
- Studies have shown that the sensitivity and specificity of Pap tests vary depending on the grade of cervical intraepithelial neoplasia (CIN) 6.
- Knowledge of the HPV status can bias cytotechnologists' interpretation of Pap tests, leading to a higher rate of upgrading to atypical squamous cells of undetermined significance (ASCUS) or worse 3.
Clinical Significance
- A negative Pap test result does not necessarily rule out the presence of cervical lesions or malignancy, and further investigation may be necessary in some cases 5, 6.
- The management of patients with atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesions (LSIL) needs to be re-evaluated, as these conditions can be associated with underlying pathology 4, 5.