الفهرس 
Normal Vaginal FloraOnly 14 pages are availabe for public view
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Abstract
Genital mycoplasma (G.M) is sexually transmitted disease. In patients with cervical malignancy there is alteration in the normal vaginal environment by necrotic tissue and blood that leads to changes in vaginal flora and increase incidence of genital mycoplasma and B.V infection, also women with recurrent & persistent genital mycoplasma and bacterial vaginosis are at high risk to develop cervical intra epithelial neoplasia (CIN).
This is a prospective cross-sectional hospital based open study, finally recruited 300 women among those attending the Gynecology Outpatient Clinics of Benha University Hospital.
Cases of the study were scheduled according to cytology report into two equal groups. The control group included 150 women with negative Pap smear for cervical atypia. The study group included 150 women with cervical squamous cell atypia recruited according to the order of diagnosis by Pap smear. The cytological report utilized the 2001 Bethesda System and identified 3 degrees of cervical atypia: atypical squamous cells of undetermined significance (ASC-US); low-grade squamous intraepithelial lesion (L-SIL); and high-grade squamous lesion (H-SIL).
All the studied cases (300 cases) were subjected to the following:
I. Clinical history taking.
II. Clinical examination.
e.g general & abdominal examination
III. Local examination.
Methods-:
Sample collection and processing: was performed during the postmenstrual period, after exclusion of recent sexual intercourse or vaginal douching during the previous 48 hours. The patient was placed in lithotomy
Position. Cervix was exposed through introduction of a non lubricated sterile Cusco speculum into vagina.
1-Papanicolau (Pap) smear: Sample was collected from the uterine cervix by rotating the Ayer’s spatula 360ْ around the uterine ectocervix for scraping of the transformation zone. The sample was then smeared on a glass slide and immediately fixed by spraying with cytospray (ethyl alcohol) then sent to the cytopathology laboratory for staining and reading through the optical microscope. 2- Bacteriological specimen: sterile swabs were used to obtain discharge from the posterior vaginal fornix and endo cervix for diagnosis of presence or absence of genital mycoplasma (M. hominis and U. urealyticum) by mycoplasma IST -2 kits (bioMe@ rieux, Marcy-L’etoile, France).
Mycoplasma IST 2 (BioMerieux France).
The mycoplasma IST2 is a test for identification of urogenital mycoplasmas by cultivation, biochemical identification, indicative enumeration and antibiotic susceptibility testing to (doxycycline, josamycin, ofloxacin, erythromycin, tetracycline, pristinamycin, azithromycin, clarythromycin, ciprofloxacin) and interpreted according to manufacturer’s instructions. Samples were considered as positive for M. hominis and U. urealyticum for values ≥104 Color Changing Unit (CCU) per milliliter of the specimen.
Summary of the result
Using Mycoplasma IST2 kit, genital mycoplasmas were positive in (49.33% vs. 28.67%) of cases in study and control groups respectively. Ureaplasma urealyticum was isolated more frequent than mycoplasma hominis and mixed mycoplasma infection. Ureaplasma urealyticum colonization was demonstrated in women with HSIL (57.5%) significantly more frequent compared to women with LSIL (36.59%), ASCUS (30.43%), and with normal cytology (21.33%); p =0.019.
Conclusion
Ureaplasma urealyticum was present significantly more often in women with cervical cytological atypia, suggesting that the existence of an association between cervicovaginal infections with Ureaplasma urealyticum and precancerous lesions of the uterine cervix was present.
Recommendations
1-As cancer cervix is a preventable disease and as genital mycoplasma might be a risk factor for CIN. so further attention toward GM patients should be taken for screening for cervical atypia and early treatment of the condition .
2- Further studies should be carried out with larger number of cases to unmask the exact relation & mechanism of action of GM in the pathogenesis of pre-malignant lesions of cervix .
3- Correlation of G. mycoplasma infections with HPV infections and cervical histopathology should be identified by further studies.
4- Mycoplasma IST2 kits exhibited good correlation with polymerase chain reaction (PCR) results in detection of Ureaplasma strains, but PCR is still needed to differentiate U. parvum and U. urealyticum