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.