الفهرس 
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Abstract
This work was done to study the problem of clinically
diagnosed cervicitis ; bacteriologically cytologically,
colposcopically and pathologically and to correlate the
findings for better understanding of this problem .
In the study 150 female patients with clinically
diagnosed cervicitis were investigated cytologically
bacteriologically, colposcopically and histopathologically.
For comparison 50 females with clinically healthy looking
cervices were similarly investigated .
For every patient , a full history was taken and
general and vaginal examination was done Specimens were
obtained from the mucus in the endocervical canal by cotton
tipped swabs and four smears were prepared
1) Physiologic, saline wet mount
2) Wiff test and KOH wet mount
3) Gram - stained smear.
4) Giemsa - stained smear
A pancervical specimen was taken by an Ayre’s spatula
and stained by Papanicolaou’s method. After that, every
patient was examined colposcopically . In every case of the
study group • a colposcopically directed biopsy was taken by
a punch biopsy forceps from the area of the cervix showing
maximum colposcopic inflammatory changes and from any area
showing abnormal colposcopic findings In the control
group, a punch biopsy was taken from any area of theT.Z.
Analysis of the clinical. cytological, bacteriological
and pathological findings enabled us to classify
the results into the following groups :
1) Trichomonas Vaginalis
Ths use of the wet and Pap. smears revealed T.V.in
28.0% of the study group and in 4% of the control group.
Wet smear revealed 78.6% of cases while Pap. smear
revealed 64.3% . Therefore, wet smear was more reliable in
diagnosing T.V. infection.
Colposcopic examination revealed inflammatory changes
in 89.7% of cases . Red punctate vaginitis was found in
31.1%, infected T.T.Z. in 24% infected A.T.Z. in 10.4%
and focal vaginitis in 10.4%. T.V. was found in all cases
of focal vaginitis. The double crested capillary pattern
was found in 65.5% of cases.
The discharge characteristic of T.V. infection was seen
in only 10.3% of cases and the strawberry cervix in 6.9% .
2) Candidiasis:
The use of the wet smears. Pap. smears and Gram
stained smears revealed candida albicans in 22.7% of the
study group and in 8% of the control group . Gram stained
smears were more reliable in diagnosing candidiasis than the
wet mount and the Pap. smear . Gram stained smear revealed
100% of cases the wet mount revealed 70.6% and the Pap.
smear revealed only 41.2%
The discahrge characteristic of candidiasis was only
seen in 11.1% of cases. We can conclude that diagnosis of
candidiasis on clinical grounds alone is unreliable.
Candidiasis had no specific colposcopic appearance
Colposcopy revealed white punctate vaginitis in 33.3%
infected T.T.Z in 22.2% and red punctate vaginitis in 14.8
75.0% of cases of white punctate vaginitis were caused by
candidiasis .
3) Gardnerella Yaginalis
The use of the whiff test , Gram stained smear , Pap.
smear and wet smear revealed G. V in 14.7% of the study
group and in 2% of the control group . The wet smear , Gram
stained smear and Pap. smear revealed G.V. in 81.8% , 63.6%
and 40.9% of cases respectively. In 9.1% of wiff positive
test ,the clue cells were not found and in these case T.Y.
was found
The vaginal discharge characteristic of G.V. infection
was seen in 90.9% of cases.
G.V. had a non-specific colposcopic appearance.
4) Chlamydia Trachomatis
The use of Pap. smear and Giemsa stained smear revealed
C.T. in 4.7% of the study group and in 2% of the control
group . Giemsa stained smear was more reliable in diagnosing
C.T. than Pap. stained smear. Giemsa stained smear revealed
85.7% of cases. while Pap. stained smear revealed 42.8% of
cases
Colposcopy revealed infected T.~Z.with exophytic ectopy
in 75% and AT.Z.in 25% of cases.
5) Human Papillomavirus Infection
The use of the Pap. smear , colposcopy and histopathology
revealed H.P.Y. in 6.0% of the study group. Pap.
smear and colposcopy revealed H.P.Y. in 44.4% and 55.5% of
cases respectively It is difficult to differentiate
between HPY and CIN colposcopically . Histological evidence
of H.P.Y. was found in 80% of biopsies from patients whose
lesions were thought at colposcopy to be a warty lesion, but
in only 2.1% of biopsies from patients with no colposcopic
evidence of such lesions .
6) Cervical Intraepithelial Neoplasia :
The diagnosis of CIN was made on pathological grounds
in 10.7% of the study group and in 4.0% of the control
group. The false positive rate of cytology was 35.3% . The
false negative cytology rate was 4.5% in cases with normal
vaginal cytology and 3.6% in those with inflammatory smears.
The colposcopic and cytologic accuracy in prediciting
CIN are equal being 64.7% Unsatisfactory colposcopy was
found in 2% of our cases .
CIN was present in 21.4~of cases of T.V, 22.2% of cases
of H.P.V ., and 28.6% of cases of chlamydia.
7) Acanthotic Epithelium
The diagnosis of acanthotic epithelium was made on
pathological grounds in 8.7% of the study group and in 4% of
the control group.Acanthotic epithelium produces no specific
cytological changes as that of CIN. The Pap. smear was
inflammatory in 76.8% and the colposcopic examination
revealed inflammatory changes in 84.6% .