Patients reported with inflammatory atypia on Pap smears demonstrated
a significantly improved rate of reversion to normal cytology
following treatment with MetroGel-Vaginal (metronidazole 0.75%
vaginal gel), according to a study presented at the District IV
Junior Fellow meeting of the American College of Obstetricians
and Gynecologists by Dr. Michael D. Randell, an obstetrician and
gynecologist in Atlanta, Georgia.
Dr. Randell said this finding is important to women and their
physicians, who are often confused about the significance and
management of inflammatory atypia on Pap smears. He noted that
this problem has been estimated to occur in 5% to 10% of over
50 million Pap smears performed each year.
An inflammatory Pap smear is often a marker of lower genital tract
infections -- most frequently bacterial vaginosis (BV), the most
common vaginal infection. Bacterial vaginosis has recently been
linked as a possible cofactor with human papillomavirus (HPV)
in the development of cervical intraepithelial neoplasia (CIN).
CIN is a premalignant change in the cervical epithelium that can
progress to the development of cervical cancer.
Because of the possibility that inflammatory atypia seen on Pap
smears is often due to undiagnosed bacterial vaginosis, Dr. Randell
conducted a comparative study of therapies for this cytological
condition. In this retrospective study of 215 evaluable women
diagnosed with inflammatory atypia on Pap smears, 59 of the patients
were prescribed MetroGel-Vaginal, 52 were prescribed triple sulfa
cream, and 104 women received no treatment as the control group.
Of the women treated with MetroGel-vaginal, 86.4% had normal cytology
on repeat Pap smears, compared with 61.5% of those treated with
triple sulfa cream and 53.8% of those who received no treatment.
"Treatment of patients whose Pap smears were reported as
inflammatory atypia with MetroGel-Vaginal substantially improves
the rate of reversion to normal cytology based on our findings
from repeat Pap smears 3 months to 4 months following therapy,"
said Dr. Randell in presenting the study results.
"It is now standard in my practice for women with inflammatory
atypia to receive a follow-up Pap smear for re-evaluation after
this 3-month period," he said. "The use of MetroGel-vaginal
following an initial report of inflammatory atypia may help improve
reversion to normal cytology upon repeat exam, obviating the need
for the patient and her physician to be concerned about a more
serious underlying cervical lesion."
Dr. Randell indicated that his work is a preliminary study and
that larger studies are needed to confirm his observations.
A recent study in Acta Obstetricia et Gynecologica Scandinavica,
found that women whose Pap smears contained cells indicating BV
had a 357% increase in the incidence of CIN.