Study on koilocytosis, X-chromatin and HSV-2 in cervical smears in Nepal.

A total of 1,106 cervical smears were studied during a one year period from Feb 1999 to Feb 2000. Majority of the lesions were Inflammatory smears constituting 91.0%, Cervical intraepithelial neoplasia [CIN] and Squamous cell carcinoma [SCC] cervix constituted 8.0% and 1.0% respectively. The percentage of different grades of CIN being CIN I 85.0%, CIN II 9.0% and CIN III 6.0%. Thirty cases were taken as a study group. The commonest age group for CIN was 31-40 years 80.0% and for carcinoma cervix above 50 years 63.0%. The most common risk factors were marriage before 20 years of age 80.0% and a low socio-economic status 70.0%. The common presenting feature in CIN was pain lower abdomen 88.0%, followed by whitish discharge per vagina 60.0%. Similarly in carcinoma cervix pain lower abdomen 80.0% followed by weight loss 60.0% were the common presenting symptoms. Koilocytic change was seen in 42.1% of the cases of CIN I. The incidence of X-chromatin positivity gradually decreased as the lesion advanced, the p-value between CIN I and CIN II [p=<0.02], CIN I and CIN III [0=0.00] and between CIN III and Carcinoma cervix [p=<0.004] being significant. An association with Herpes simplex virus-2 [HSV-2] was seen in 11.0% cases of CIN I, 33.0% cases of CIN IIl and 40.0% cases of carcinoma cervix with a gradual rising antibody titre of 1:2 in CIN I, 1:7 in CIN III and 1:7 to 1:9 in carcinoma cervix respectively.