Colposcopy

Colposcopy is a diagnostic tool that is often followed after an abnormal Pap smear test. A Colposcope is much like a large electric microscope that allows the physician to visualize the cervix, vaginal and genital area.

Basically a Colposcope is a complex optical instrument using light and magnification to distinguish dysplasia and cervical cancer from benign cervical findings. The word Colposcope is derived from 'colpo' indicating a vagina and 'scope' which refers to 'look'.

The physician applies vinegar solution to look for Leukoplakia and abnormal vessels. Colposcopy aids in viewing the cervix for any abnormal vascular changes. A colposcopy is suggested when there is any abnormality observed in the cervix or there is evidence of HPV. With a camera attached, images can be saved for records. During this procedure, any tissue sample or cervical biopsy can be taken for further investigation. This may cause slight discomfort and cramping. This diagnostic tool can be helpful in detecting any inflammation, cancerous growth or infection.

Preparation before colposcopy: Some conditions may require some medications before a session of colposcopy. Atrophic vaginal or cervical epithelium can be treated with intravaginal estrogen for 2-4 weeks before colposcopy in order to 'normalize' the epithelium.

Primary indications for colposcopy include abnormal Pap results or an abnormal appearing cervix. Early detection of cervical cancer is possible with colposcopy. Colposcopy is done in cases where a woman has unexplained bleeding during intercourse or there is any abnormal tissue on the cervix, vagina or vulva.

The Papanicolaou smear (Pap smear or Pap test) is a common test for dysplasia and cancer of the uterine cervix. In the US alone more than 50 million Pap Smear tests are taken every year. The Pap test is a cytologic examination of cells from the cervical transformation zone. A Pap test is often used to differentiate malignant cysts from common and mostly benign cysts. For example, Nabothian cysts are common and considered as a normal feature of the adult cervix.

A pelvic examination can sometimes help detect cysts and polyps. Endocervical polyps are the most common benign neoplasms of the uterine cervix. They are usually asymptomatic (but sometimes may cause vaginal discharge or post coital spotting) and occur in the 40 - 60 years. Most polyps are benign and the incidence of malignancy is approximately 1 in 1000.

Roche DNA Test

Recently the Federal health, Food and Drug Administration regulators in the US cleared the Roche HPV test to detect the Human Papillomavirus in women aged 25 and above. Roche's is primarily a genetic test that could be done as a first-choice screening option for cervical cancer. This is an advance on the decades-old Pap smear.

Roche diagnostics conducted a study that provided the FDA with reasonable assurance of the safety and effectiveness. Roche's trial included 47,000 women who underwent cervical screening using either Pap or HPV screening. The results were checked for accuracy against final biopsy results that confirmed whether they actually had cancer.

As such doctors use DNA-based tools as a follow-up to confirm Pap smear results. Now, Roche DNA test can be used as a first-choice option for cervical cancer screening, ahead of the Pap test.

The FDA approval comes despite warning from health advocates that approving the DNA test as an alternative to Pap could lead to confusion, higher costs and over treatment of younger women who carry the virus that have little risk of developing actual cancer.

While Roche supported its study results suggesting that genetic testing is more accurate and objective at identifying cancerous growth than the Pap smear, there are no major medical guidelines that recommend HPV testing alone for cervical cancer screening. Some physicians and gynecologists advice holding off using the test until medical societies can provide guidance to some key questions which include how frequently it should be used.

Pap test was the only available screening option for cervical cancer for decades. Due to increased Pap screening, in the US, the number of reported cases of cervical cancer has decreased more than 50 percent in the past 30 years. Yet, an estimated 12,000 cases of cervical cancer are expected to be diagnosed this year. Hence Roche and other test markers developed HPV tests – although the cost of Roche's HPA is twice and even more as that of the Pap which is $ 40.

The American Cancer Society has tried to evolve latest guidelines incorporating both techniques. A Pap test is recommended every three years for those aged between 21 and 29 years of age and older women should have both a Pap test and an HPV test every five years, or only a Pap every three years. Also, according to FDA, women who test positive for HPV 16 or 18 should proceed directly to colposcopy, which is an invasive procedure in which the cervix is viewed with a magnifying device and often tissue sample is collected for testing. A positive test for one or more of the other 12 high-risk HPV strains should be followed by a Pap test to determine the need for colposcopy.

As women in their 20s could be exposed to the danger of more invasive testing that could leave the cervix less able to handle pregnancy later in their life if they undergo a HPV screening, they are advised not to do so.

Roche DNA test claims to have the superior ability to detect HPV DNA and individual types. It is also capable of detecting HPV genotypes present in multiple infections. This can occur in up to 35% patient samples. It uses standardized and quality controlled reagents to do the test. Due to co amplification primer concentrations are used. This minimizes competition.

It helps identify women at risk and optimizes treatment strategies. It helps further stratify women with normal cytology who are HPV positive into different categories. The test also provides physicians with actionable information to treat the highest risk patients immediately.

Cervicitis

An inflammation of the cervix mainly due to an infection is Cervicitis. The infected cells of the cervix become irritated and may become red, swollen and ooze mucus and pus. They could bleed easily when touched. The most important cause of Cervicitis is sexually transmitted disease although many women do not test positive for any type of infection though contracted with Cervicitis.

Symptoms of Cervicitis

Many women do not exhibit any symptoms and if tested may be positive for Cervicitis. If present, the signs and symptoms include:

• Vaginal discharge which could be grayish or pale yellow.
  
• Abnormal vaginal bleeding or bleeding after sex, between periods.
  
• Pain during sexual intercourse.
  
• Pelvic or abdominal pain, fever in some cases.
  
• Vaginal irritation
  
• Pain in the vagina
  
• Pressure or heaviness in the pelvis.
  

Serious symptoms might indicate a life-threatening condition and immediate medical care should be sought. If Cervicitis is suspected during pregnancy, there could be life-threatening symptoms including - high fever, severe nausea and vomiting and severe pelvic pain.

Causes of Cervicitis

Cervicitis is most often caused by an infection caught during sexual activity. Some sexually transmitted diseases include gonorrhea, Chlamydia, Herpes Virus and Trichomoniasis. Other possible causes for Cervicitis are:

• Use of a diaphragm or cervical cap insertion into the pelvic area.
  
• Allergy to condoms and latex
  
• Chemical exposure
  
• Many sexual partners
  
• High risk sexual behavior
  
• Sex at an early age.

When the vagina is overwhelmed by unhealthy and harmful bacteria, it can cause Cervicitis. Hormonal imbalance with relatively low estrogen or high progesterone may interfere with the body's ability to maintain healthy cervical tissue. Cancer treatment and radiation therapy can also cause Cervicitis.

Diagnosing Cervicitis

A doctor first gets a closer look at the cervix when Cervicitis is suspected. Then the doctor will swab the cervix, collect vaginal fluid and see how it bleeds. The patient's sexual history is noted. A routine examination of the cervix is conducted if you are pregnant or the doctor thinks that there is high risk for sexually transmitted disease like gonorrhea or Chlamydia. Inspection of the discharge under a microscope may show Trichomoniasis or Bacterial Vaginosis. Pap smear is also done. Rarely, colposcopy and biopsy of the cervix is necessary to rule out cancer.

Reducing risk of Cervicitis

You can reduce or lower the risk of Cervicitis by:

• Avoiding known allergens.
  
• Avoiding sexual intercourse.
  
• Monogamous sexual partner.
  
• Following instructions while using diaphragm or cervical cap.
  
• Getting tested for STD infections annually.
  
• Getting vaccinated against human papilloma virus.
  
• Using condoms during sexual intercourse.
  

Treatment

If sexually transmitted infection is not the cause, then you do not need treatment for Cervicitis. If an infection is suspected, the main goal would be to eliminate the infection and prevent it from spreading to the uterus and fallopian tubes, in case of pregnancy.

In case of bacterial infections such as Chlamydia, Gonorrhea and others, antibiotics are used for treatment. Antiviral drugs may be used to treat herpes infections. Hormonal therapy with estrogen and progesterone may be used in women who have reached menopause. When such treatments fail, and Cervicitis is still present for a long time, then cryosurgery, electro cauterization and laser therapy are adopted.

The doctor would prescribe the line of treatment depending upon the cause of infection. The doctor may advice antibiotics, antifungal medications and antiviral medications. The doctor may also recommend treating the partner to rule out chances of infection again. It is recommended to avoid sexual contact till the partner has finished treatment.

If medications such as Antibiotics do not work in some cases, there are other options available recently:
Loop Electro surgical Excision Procedure (LEEP)
Cryotherapy, Electrocoagulation or Laser to cauterize the affected tissue.

Tips to prevent Cervicitis

Avoid chemical irritants such as deodorant tampons. When inserting any foreign objects into the vagina, make sure that they are properly placed. Be in a monogamous sexual relationship. Use latex condom every time of sex to lower the risk of getting sexually transmitted infections. A condom must be properly used every time.