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PubMedDate not supplied

Histologic and clinical characteristics associated with rapidly progressive invasive cervical cancer: a preliminary report from the Yale Cancer Control Research Unit.

Histologic and clinical characteristics associated with rapidly progressive invasive cervical cancer are presented in this preliminary report from a population-based study involving all patients in Connecticut diagnosed with cervical cancer from March 1, 1985. Rapidly progressive invasive cervical cancer, i.e., invasive cancer diagnosed within three years of a true negative Pap smear, is more likely to occur in younger women with high annual incomes (61 percent greater than $40,000) who report a greater frequency of benign gynecologic conditions (uterine leiomyomata, vaginitis) compared to a control cervical cancer group. These preliminary data suggest that as many as 35 percent of the rapidly progressive cervical cancers are likely to be adenocarcinomas. Because they are mostly endocervical in origin, they may not be detected cytologically if scrapers or cotton swabs are used to sample the endocervical canal. New cytologic screening techniques using brushes may identify these lesions earlier and should routinely be employed in cytologic screening for cervical neoplasia. The difficulty in early detection of this form of the disease requires that physicians rapidly assess patients with unexplained pelvic and lower abdominal pain, vaginal discharge, or abnormal vaginal bleeding since early recognition is the only chance for cure. Further analyses of this population of women will be made to identify additional risk factors when the study data are complete.

Adenocarcinoma↗
PubMedDate not supplied

Study on treatment of bacterial vaginosis with oral administration of metronidazole or cefdinir.

Bacterial vaginosis (BV) is considered to be one of the most common vaginal infections in women. Fifteen symptomatic women with BV were enrolled in this study. Ten patients with the diagnosis of BV were treated with 10 days oral administration of metronidazole (MTN), 500 mg twice a day, and five patients with cefdinir (CFDN), 300 mg three times a day. In the MTN therapy, the rate of abnormal vaginal discharge subjectively decreased from 100 to 60%, the rate of abnormal vaginal discharges objectively decreased from 100 to 20%, the rate of positive amine tests decreased from 100 to 20%, the rate of genital malodor and abnormal pH of vaginal discharges decreased substantially from 100 to 10%, and the rate of the presence of clue cells also decreased notably from 90 to 10%. However, in the CFDN therapy, none of these factors improved. With respect to susceptibility to CFDN and MTN, CFDN demonstrated good antibacterial activity against almost all bacteria isolated except Gardnerella vaginalis. On the other hand, MTN demonstrated excellent activity against anaerobic bacteria except Peptostreptococcus spp., and had no antibacterial activity against aerobic bacteria. Since the therapeutic effect of MTN in BV appeared to be better than that of CFDN, anaerobes may play a major role in causing clinical symptoms in patients with BV.

Administration, Oral↗
PubMed2004

Reproductive tract infections in rural women from the highlands, jungle, and coastal regions of Peru.

OBJECTIVE: To define the prevalences and manifestations of reproductive tract infections (RTIs) in rural Peruvian women. METHODS: During 1997-98, we visited 18 rural districts in coastal, highlands, and jungle regions of Peru. We administered standardized questionnaires and pelvic examinations to members of women's community-based organizations; and collected vaginal fluid for pH, amine odour, Gram stain, microscopy, and culture for Trichomonas vaginalis; cervical specimens for Chlamydia trachomatis, Neisseria gonorrhoeae; human papilloma virus (HPV) by polymerase chain reaction (PCR) assays, and blood for syphilis serology. FINDINGS: The 754 participants averaged 36.9 years of age and 1.7 sex partners ever; 77% reported symptoms indicative of RTIs; 51% and 26% reported their symptoms spontaneously or only with specific questioning, respectively. Symptoms reported spontaneously included abnormal vaginal discharge (29.3% and 22.9%, respectively). One or more RTIs, found in 70.4% of participants, included bacterial vaginosis (43.7%), trichomoniasis (16.5%), vulvovaginal candidiasis (4.5%), chlamydial infection (6.8%), gonorrhoea (1.2%), syphilis seropositivity (1.7%), cervical HPV infection (4.9%), and genital warts or ulcers (2.8%). Of 715 adequate Pap smears, 7 revealed cancer, 4 high-grade squamous intra-epithelial lesions (SIL) and 15 low-grade SIL. Clinical algorithms had very low sensitivity and predictive values for cervical infection, but over half the women with symptoms of malodorous vaginal discharge, signs of abnormal vaginal discharge, or both, had bacterial vaginosis or trichomoniasis. CONCLUSION: Overall, 77% of women had symptoms indicative of RTIs, and 70% had objective evidence of one or more RTIs. Women with selected symptoms and signs of vaginal infection could benefit from standard metronidazole therapy.

Adolescent↗
PubMed1992

Comparison of the vaginal flora in sexually abused and nonabused girls.

The presence of sexually transmitted pathogens in the vagina of the sexually abused girl may provide direct evidence of sexual abuse; the presence of other abnormal vaginal organisms may provide indirect evidence of abuse. To identify abnormal vaginal organisms, we prospectively studied the flora of 209 sexually abused girls (cases) and compared it with that in a concurrent control group of 108 girls. Case and control subjects were from the same community, were predominantly white, and 71% of each group were 3 to 10 years of age. The sexually transmitted pathogens (Neisseria gonorrhoeae, Trichomonas vaginalis, Chlamydia trachomatis, herpes simplex virus) were isolated exclusively from the case group at a low frequency (less than 1%). The isolation of Mycoplasma species exclusively in the case group (4%), and of Gardnerella vaginalis in 7% of the case group versus 1% of the control group, suggests that both these organisms may be sexually transmitted. Other bacteria also were collectively more frequent in the case group (16% vs 6%). There may be an association between sexual activity and colonization of the lower genital tract in young girls.

Child↗
PubMed2000

Prevalence of bacterial vaginosis in women attending one of three general practices for routine cervical cytology.

A prospective observational study of asymptomatic women from three different general practices was set up to establish the incidence of bacterial vaginosis (BV). The study group comprised 287 women recalled to their general practitioner's surgery for routine cervical smears. The prevalence of an abnormal vaginal flora was about the same in women attending the 3 practices. Nearly 14% of women had abnormal vaginal flora and about 9% had BV on gram stain examination of vaginal secretions. This was 2-3 times more common than findings consistent with vaginal candidiasis (3.8%). Significant numbers of women with BV had received antifungal therapy suggesting a misdiagnosis. Because of its potential complications, women should be offered screening for BV in a well-women setting and, if found, should be treated if symptomatic or at risk of adverse obstetric or gynaecological sequelae.

Adult↗
PubMedDate not supplied

Comparison of Pap test among high and non-high risk female.

A prospective study of pap smear in 100 high risk and equal number of non high risk female among total 1022 female Gynecological patients within a period of two and half months {Beginning of Sept. to middle of Nov. 1995} in Maternity Hospital, Thapathali is presented. There were 9 cases positive for dyskaryosis among high risk and 3 cases among the comparison group. All positive cases were at the age of 35 years and above. In 9 positive cases, 5 cases were in CIN I (55.55%) while 4 were in CIN II (44.44%). Similarly out of 3 positive cases in comparison group 1 was in CIN I category (33.33%) and 2 cases were in CIN II (66.66%). Relation of positive cases with low social class revealed 80% CIN I and 50% CIN II among high risk group where as 66.6% CIN II in comparison group. Analysis of risk factor in development of various grades Dyskaryosis revealed 60% of CIN I had high parity while 50% had CIN II. There are about 40% of CIN I and 75% CIN II among child birth less than 19yrs, 60% smoker had CIN I where as 100%. Smoker had CIN II. 80% of CIN I gave history of excessive vaginal discharge where as 50% of CIN II had excessive vaginal discharge. 40% of CIN I was having injection Depo provera. Cases were also analyzed according to risk factor. Out of 9 positive cases among high-risk females 5 positive had parity more than 4 and 4 cases had less than 4. 5 positive cases were among less than 19 years of first childbirth, 4 among more than 19 years. 7 positive cases were smoker and 2 positive cases were non-smoker. 6 positive cases gave history of abnormal vaginal discharge and 3 positive cases had no abnormal vaginal discharge. Out of 9 positive cases 2 had history of injection Depo provera continuously for more than 5 years where as 7 were non users.

Adolescent↗
PubMed1998

Papillary serous carcinoma of the uterine cervix: a clinicopathologic study of 17 cases.

The clinical and pathologic features of 17 cases of papillary serous adenocarcinoma of the cervix (PSCC) were studied in women who ranged in age from 26 to 70 years. There was a bimodal age distribution, with one peak occurring before the age of 40 years and the second peak after the age of 65. The presenting symptoms were abnormal vaginal bleeding (11 patients), abnormal exfoliative cervical cytology (four patients), or watery vaginal discharge (two patients). On pelvic examination, eight patients had a polypoid or exophytic cervical mass and two patients had an ulcerated or indurated cervix; no abnormality was detected in seven patients. Two tumors were stage Ia, 12 were stage Ib, two were stage II, and one was stage III. Nine patients were treated by radical hysterectomy and one by simple hysterectomy; six of these patients received postoperative radiotherapy. The other patients received primary radiotherapy. On microscopic examination, all of the tumors had a complex papillary architecture with epithelial stratification and tufting. Six tumors were grade 2/3 and 11 were grade 3/3. All of the tumors had >10 mitotic figures per 10 high-power fields. An intense acute and chronic inflammatory infiltrate was typically present within the cores of the papillae and in areas of stromal invasion. Occasional psammoma bodies were present in three cases. Five of 12 tumors stained positively for p53, with six and nine of 12 tumors, respectively, immunoreactive for carcinoembryonic antigen and CA-125. Seven tumors were mixed with another histologic subtype of cervical adenocarcinoma, most commonly low-grade villoglandular adenocarcinoma. Fifteen patients were followed from 6 months to 11 years (mean 56 months). Six patients died of extensive metastases within 5 years of diagnosis; an additional patient experienced tumor recurrence with malignant ascites 2 years after diagnosis. The most common metastatic sites were pelvic and periaortic lymph nodes; other sites included cervical lymph nodes, lung, peritoneum, liver, and skin. Eight patients were alive without evidence of tumor at last follow-up. Age <65 years, stage >I, tumor size >2 cm, tumor invasion >10 mm, the presence of lymph node metastases, and elevation of serum CA-125 were associated with a poor prognosis. Tumor grade or composition (pure or mixed) did not correlate with patient outcome. Papillary serous adenocarcinoma of the cervix resembles microscopically its counterparts elsewhere in the female genital tract and peritoneum. The tumors can behave aggressively with supradiaphragmatic metastases and a rapidly fatal course when diagnosed at an advanced stage, but the outcome for patients with stage I tumors is similar to that of patients with cervical adenocarcinomas of the usual type.

Adult↗
PubMed2006

Changing behaviors and patterns among Cambodian sex workers: 1997-2003.

OBJECTIVE: Identify patterns and behaviors among direct and indirect female sex workers (DFSWs and IDFSWs, respectively) across Cambodia's 5 major cities from 1997 to 2003. METHODS: Interviews with DFSWs and IDFSWs followed random selection from clusters in 5 cities. Individual characteristics and condom use with clients and other partners were assessed in univariate and multivariate analyses. RESULTS: From 1997 to 2003, consistent condom use with clients increased from 53% to 96% among DFSWs and from 30% to 84% among IDFSWs. DFSWs reported staying in their profession longer, had fewer clients per day, stayed longer in each brothel, were in increasingly larger brothels, and were tested more for HIV. For IDFSWs, there were significant changes: more reported practicing commercial sex and testing for HIV. In adjusted models, reported condom use with clients was significantly higher among DFSWs in later survey years (odds ratio [OR], 2.17) and who were never married (OR, 1.69), were in larger brothels (OR, 1.02), and charged more for sex (OR, 1.27), but lower for DFSWs with sweethearts (OR, 0.68) and who reported abnormal vaginal discharge (OR, 0.52). For IDFSWs, in the adjusted models, reported condom use with clients was higher in later years (OR, 1.77) and for those reporting abnormal vaginal discharge (OR, 1.34) and HIV testing (OR, 1.46), and lower for those with sweethearts (OR, 0.49). CONCLUSIONS: From 1997 to 2003, Cambodian direct and indirect sex workers increased their use of condoms each year with commercial as well as noncommercial partners, contributing to the evidence that HIV prevention programs can produce significant changes in risk behaviors.

Adult↗
PubMed1990

Epidemiology of HIV infection among prostitutes in the Philippines.

Between 1985 and 1987, examinations for human immune deficiency virus (HIV) antibody were done on 25,392 prostitutes working in 64 cities throughout the Philippines. The country-wide seropositivity rate among prostitutes based on this sample was 0.8/1,000. Of the HIV cases, 85% were working in just two cities whose prostitute populations comprised 50% of the total sample. The average incidence rate for the same two cities after 1 year was 2.3/1,000. HIV antibody-positive women were enrolled in a case-control study to determine demographic and epidemiologic risk factors. This study involving 34 HIV-positive prostitutes and 61 randomly selected negative control prostitutes did not reveal any risk factors related to sexual or other types of behavior. A history of genital warts, a history of abnormal vaginal discharge, and cytomegalovirus antibody were significantly more frequent in the HIV-positive cases than in the controls; however, by logistic regression analysis, only an abnormal vaginal discharge was independently associated with HIV infection. Absence of any evidence of transmission by blood transfusion or i.v. drug abuse suggests that HIV was introduced by the heterosexual route.

Adult↗
PubMed1985

Primary malignancies of the fallopian tube.

Ten cases of primary adenocarcinoma of the fallopian tube occurring over 23 year period are presented. The mean age of the patients was 61.2 +/- 9.2 years (range 48-77). Eight of the patients were postmenopausal. Abnormal vaginal bleeding was the most common symptom and was present in six patients. A pelvic mass was detected in seven cases. In one of the patients abnormal vaginal cytology was leading to correct diagnosis. The problem of the disease is a late diagnosis. Eight of the ten patients with tubal adenocarcinoma represented clinical Stage III or IV. Four of the patients are alive more than ten years after the diagnosis. A rare case of carcinosarcoma of the fallopian tube is presented. Only 26 such cases have been described in the literature to date. In addition a case of tubal choriocarcinoma is reported.

Adenocarcinoma↗
PubMed2004

Natural history of bacterial vaginosis and intermediate flora in pregnancy and effect of oral clindamycin.

OBJECTIVE: We sought to describe the natural history of abnormal vaginal flora in pregnancy and estimate the efficacy of oral clindamycin in eradicating it and preventing relapse. METHODS: This was a subanalysis of a randomized trial of oral clindamycin for abnormal vaginal flora in pregnancy. All 494 enrolled women were asked to provide a vaginal smear 2 weeks after treatment and every second participant to provide further smears at 20, 24, 28, 32, and 36 weeks of gestation. We used Nugent score of Gram-stained smears to assess the cure rate among the clindamycin group and the rate of spontaneous resolution among the placebo group. RESULTS: Posttreatment smears were available for 462 women (231 in each of the clindamycin and placebo arms). The prevalence of abnormal flora posttreatment was 10% (22 of 231) in the clindamycin group compared with 93% (214 of 231) in the placebo group (P <.001). Two hundred nineteen women obtained 4 weekly smears; slides for 84 women were lost, and results were available for 135 women (69 clindamycin, 66 placebo). In the clindamycin group, the prevalence of abnormal flora was 15% at 20 weeks of gestation and 17% at 36 weeks of gestation compared with 69% at 20 weeks of gestation and 43% at 36 weeks of gestation in the placebo group. CONCLUSION: Oral clindamycin eradicated abnormal flora in 90% of treated pregnant women and maintained a normal flora in two thirds of women throughout pregnancy. Almost one third of untreated women in our study had spontaneous resolution of abnormal flora by 20 weeks of gestation. Because previous research has shown that spontaneous resolution does not modify the risk of preterm birth, early screening is essential.

Administration, Oral↗
PubMed2005

Why do women complain of vaginal discharge? A population survey of infectious and pyschosocial risk factors in a South Asian community.

BACKGROUND: Vaginal discharge is a common complaint, particularly among women in Asia. Although presumed to be caused by reproductive tract infections (RTIs), the association between the complaint and the presence of RTIs is weak. This study aimed to investigate the risk factors of the complaint of vaginal discharge. METHODS: We conducted a community-based survey of 3000 women aged 18-50 years, randomly sampled from a population in Goa, India. Women who gave informed consent were invited to participate in a structured interview, which elicited data on the primary outcome (the experience of current abnormal vaginal discharge) and psychosocial exposures: gender adversity; symptoms of somatoform disorders; and common mental disorders (CMD). All women were required to provide vaginal and/or urine samples for diagnosis of RTIs using gold standard laboratory tests. Risk factors were analysed using logistic regression with the binary outcome of the complaint of vaginal discharge. RESULTS: Of the 2494 women (83%) who agreed to participate, 14.5% complained of having an abnormal vaginal discharge. Stress was the most common causal attribution for the complaint. The final multivariate model found that high scores for CMD (OR 2.16, 1.4-3.2) and somatoform disorders (6.23, 4.0-9.7) and the use of an intrauterine contraceptive device (1.86, 1.0-3.4) were independently associated with the complaint. Low literacy (0.54, 0.4-0.8) and age >40 years (0.29, 0.2-0.4) were associated with a reduced risk. RTI were not associated with the complaint (1.24, 0.9-1.6). CONCLUSIONS: Psychosocial factors have the strongest association with the complaint of vaginal discharge. Syndromic management algorithms need refinement so that women with complaints that are non-infectious in aetiology are offered psychosocial interventions.

Adolescent↗
PubMed2000

Bacterial vaginosis in a family practice population.

BACKGROUND: To determine and evaluate the prevalence of bacterial vaginosis diagnosed according to three sets of diagnostic criteria in three well-defined groups of non-pregnant women attending a family practice, and to determine the proportion of women diagnosed with bacterial vaginosis during a year involving the entire population registered at the practice. METHODS: During a year, bacterial vaginosis was diagnosed both according to the composite clinical diagnosis, a new wet mount diagnosis, and Nugent's gram stain diagnosis for bacterial vaginosis in women of reproductive age attending with new episodes either of abnormal vaginal discharge, other genito-urinary symptoms, or for a routine check-up. RESULTS: In non-pregnant women, bacterial vaginosis was diagnosed in a third of those with abnormal vaginal discharge (n=189), and in a tenth of those without, regardless of whether they had other genito-urinary symptoms (n=186) or not (n=273). Including all examined women, at least 11%, 13%, and 16% of the 880 women registered at the practice, were diagnosed with bacterial vaginosis according to the composite clinical, the wet mount, and the gram stain diagnoses, respectively. The results were based on the 57% of the women who attended during the year. The prevalence data differed significantly according to which diagnostic method we used, the composite clinical lowest, the wet mount intermediate, and the gram stain highest. CONCLUSION: Both well-defined criteria of inclusion and unison diagnostic procedures are necessary for reliable comparison and generalization of prevalence data of bacterial vaginosis.

Adolescent↗
PubMed1999

Accuracy of rapid antigen detection test for group B streptococci in the indigenous vaginal bacterial flora.

OBJECTIVE: To test the sensitivity of the rapid group B streptococci (GBS) antigen test ICONR and compare its accuracy in women with vaginal enterococci or with non-specific disturbance of the lactobacillary flora. STUDY DESIGN: The ICONR, aerobic culture and a microscopic wet mount evaluation were done on a vaginal sample in 254 unselected women presenting for routine gynecologic care in an academic hospital in Flanders, Belgium and tested by Chi2 [diagnostic odds ratio (DOR) and its 95 percent confidence limits]. RESULTS: Sensitivity of the test was 70%, specificity 99.5%. Prevalence of GBS was 10.6% overall, 23% in the group with abnormal vaginal flora and 7% in the normal group (p=0.002). Accuracy of the ICONR was not affected by abnormal vaginal flora, but was significantly lower in the presence of enterococci: the DOR decreased from 490 to 58, and the positive predictive value from 94 to 80%. CONCLUSION: With a sensitivity of 70% the enzyme immunoassay ICONR does not appear to be suitable as a practical screening tool for detecting GBS carriage in normal or preterm laboring women. In the presence of enterococci the test performed less well, with a DOR falling by 8 to 9 fold. We presume this is due to lower specificity in vivo in the presence of enterococci, as non-specific disturbance of the lactobacillary flora did not interfere with test results.

Bacteriological Techniques↗
PubMedDate not supplied

Association between abnormal microbiological flora of the lower genital tract in early pregnancy and socio-economic, demographic and environmental risk factors.

BACKGROUND: The main aim of this study was to determine the socioeconomic, demographic and environmental factors which may be associated with the occurrence of pathological microflora of the lower genital tract in early pregnancy. MATERIAL AND METHODS: A group of 96 pregnant women was selected at random from the patients of 10 district maternity units in the Lodz region of Poland. Only singleton pregnancies below 24 weeks were qualified for inclusion in the survey. A standard questionnaire covering medical, socio-economic, demographic, constitutional, and environmental items was administered to every subject and checked against medical records. Based on microbiological results, two groups of pregnant women were distinguished: Group I, with normal cervicovaginal flora, predominantly Lactobacillus spp. with coagulase-negative staphylococci and viridans streptococci, and Group II, with abnormal flora. The latter included two subgroups: IIA, intermediate microbial flora, dominated by M. hominis, U. urealyticum, G. vaginalis, gram-negative anaerobic rods, Ch. trachomatis, and few Lactobacillus spp, and IIB, highly abnormal flora, containing similar microbial components as in IIB but without Lactobacillus spp. RESULTS: Based on the results of microbiological culturing, 18 (18.7%) of the 96 women examined were classified to Group I, and 78 (81.2%) to Group II: 32 (33.3%) in group IIA and 46 (47.9%) in IIB. Groups IIA and IIB were combined for further analysis. An excessive risk of abnormal vaginal flora was observed in connection with such socio-economic factors as marital status, unemployment, and smoking, Moreover, the first pregnancy was also found to be a potential risk factor for this pathology. The risk of developing abnormal vaginal flora, although exceeding unity for each of these factors, was not considered statistically significant. CONCLUSIONS: Socio-economic and environmental factors may influence the course and outcome of pregnancy. Pregnant women who present with risk factors for abnormal cervicovaginal microflora should be included in comprehensive prenatal surveillance, which enables early detection and treatment of this pathology.

Bacteria↗
PubMed1996

Cervical and vaginal cytologic smears suggestive of adenocarcinoma.

OBJECTIVE: To determine the appropriate evaluation of women with cervical cytologic smears suggestive of adenocareinoma. STUDY DESIGN: Of 1,192,972 smears obtained between July 1989 and March 1992, 57 (0.005%) were interpreted as adenocarcinoma, adenocarcinoma in situ or "rule out" adenocarcinoma. Review of medical records allowed the determination of pathologic diagnoses in 46 of 57 women. Thirty of the 46 cytologic smears were reviewed. RESULTS: Fifteen of the 46 women were premenopausal and < 50 years of age. Twenty-three were asymptomatic, 22 had abnormal vaginal bleeding, and 1 had increasing abdominal girth. Twenty-nine (63%) of the 46 women had cancer, 12 (26%) had cervical intraepithelial neoplasia 2 (CIN 2) or 3, and 5 (11%) had CIN 1, condyloma or no pathology. Of the 29 women with cancer, 11 had cervical cancer, 1 had vaginal cancer, 13 had uterine cancer, and 4 had extrauterine cancer. Nineteen of 22 women (86%) with abnormal vaginal bleeding had cancer; 9 of 23 asymptomatic women had cancer (39%) (chi 2 = 9.84, P < .01). DISCUSSION: Women with smears suggestive of adenocarcinoma require biopsy of cervical or vaginal masses, colposcopy with directed biopsy, endocervical curettage and endometrial biopsy. If cancer is not diagnosed, cervical conization with dilatation and curettage (D&C) is indicated. If conization with D&C is negative, laparoscopy is indicated to exclude extrauterine cancer.

Adenocarcinoma↗
PubMed1997

Genital shedding of human immunodeficiency virus type 1 DNA during pregnancy: association with immunosuppression, abnormal cervical or vaginal discharge, and severe vitamin A deficiency.

The presence of human immunodeficiency virus type 1 (HIV-1) in genital secretions may be a determinant of vertical HIV-1 transmission. Cervical and vaginal secretions from HIV-1-seropositive pregnant women were evaluated to determine prevalence and correlates of HIV-1-infected cells in the genital tract. HIV-1 DNA was detected by polymerase chain reaction in 32% of 212 cervical and 10% of 215 vaginal specimens. Presence of HIV-1 DNA in the cervix was associated with cervical mucopus and a significantly lower absolute CD4 cell count (354 vs. 469, P < .001). An absolute CD4 cell count <200 was associated with a 9.6-fold increased odds of cervical HIV-1 DNA detection compared with a count > or = 500 (95% confidence interval, 2.8-34.2). Detection of vaginal HIV- 1 DNA was associated with abnormal vaginal discharge, lower absolute CD4 cell count, and severe vitamin A deficiency. Presence of HIV-1-infected cells in genital secretions was associated with immunosuppression and abnormal cervical or vaginal discharge.

Adolescent↗