CLINICAL FEATURES AND MANAGEMENT OF PATIENTS WITH DYSPLASIA OF CERVICAL EPITHELIUM ON THE BACKGROUND OF ABNORMAL MICROBIOCENOSIS OF VAGINA

Aim. The aim of the research was to study the features of mild cervical dysplasia (CIN I) and determine the management of patients with such abnormal cytological results found in cervical screening against bacterial vaginosis and HPV infection. Materials and methods. The study included 252 patients aged 19 to 35. Ill-defined cells were detected during cytological screening. All patients were divided into 2 groups. The first group consisted of 93 patients with ASC-US cytological Bethesda classification results. The second group included 159 women with LSIL cytological Bethesda classification results. PCRdiagnostics was performed to determine qualitative and quantitative composition of genital tract microflora. The presence of 16th, 18th, 31st, 33rd, 35th, 39th, 45th, 51st, 52nd, 56th, 58th, 59th types HPV was detected. Patients with HPV-infection underwent widened colposcopy with evaluation of the grade of abnormal colposcopy findings.

Results. In the 1st group the bacterial vaginosis was diagnosed in 83,9% of women, HPV – in 39,7%, trichomoniasis – in 7,5% of patients. In the 2nd group bacterial vaginosis was diagnosed in 64,8% of patients, HPV – in 78,0%, trichomoniasis – in 2,5%. In the 2nd group the incidence of abnormal colposcopy findings was twice higher than in 1st group. Patients underwent uterine cervix biopsy. Biopsy material was subjected to histological investigation. In the 1st group (n=22) 50,0% of patients had mild cervical dysplasia (CIN I), 9,1% – had moderate cervical dysplasia (CIN II). In the second group (n=61) 68,8% of patients had mild cervical dysplasia (CIN I), 9,83% – had moderate cervical dysplasia (CIN II). Patients of both groups were treated for 3-6 months. They underwent control cytological and microbiological studies after the treatment. The recurrence of bacterial vaginosis was 4,3% in 1st group and 14,0% in 2nd group. In 1st group 16,43% of patients had HPV positive test; it was positive in 19,5% of women of 2nd group. LSIL cytologicalBethesda classification results were in 1 (1,1%) patient in the 1st and in 5 (3,1%) patients in the 2nd group.

Conclusion. Bacterial vaginosis is an additional factor of progression of dysplasia in patients with HPV positive test. Patients with LSIL and ASC-US cytological Bethesda classification results need correct antibiotic therapy which should be followed by control cytological studies and HPV test. These are the main ways of cervical cancer prevention.