Abstract
Objetivo
Validar si la tinción de Papanicolaou es útil para el diagnóstico de tres de las patologías mayormente asociadas a infecciones de transmisión sexual (ITS): vaginosis bacteriana (VB), candidiasis y tricomoniasis.
Diseño
Estudio prospectivo, descriptivo y transversal.
Emplazamiento
El estudio se realizó en la Unidad de Atención Primaria Dr. José Castro Villagrana, Tlalpan, México, DF, entre enero de 1997 y febrero de 2000.
Participantes
A 271 pacientes de 16-66 años (media, 32,2) con diagnóstico de cervicovaginitis se les realizó toma de muestra cervical para tinción de Papanicolaou (Pap) y toma de muestra vaginal para pruebas de laboratorio de rutina.
Mediciones y resultados principales
La prevalencia de VB diagnosticada por criterios de Amsel fue de 33,9%, de candidiasis por cultivo de 17,3% y de tricomoniasis por fresco del 1,8%. Para VB utilizando el sistema Bethesda para interpretar el Pap se obtuvo 66% de sensibilidad y 86% de especificidad y valores predictivos positivo y negativo (VPP y VPN) del 79% y 84%, respectivamente.
Para candidiasis se obtuvo 21% de sensibilidad, 99% de especificidad, VPP y VPN de 90% y 85%, respectivamente.
Conclusiones
El Pap tiene baja sensibilidad y elevada especificidad para detectar ITS, por lo tanto parece más adecuado para excluir que para diagnosticar dichas infecciones. Tanto los métodos de laboratorio, como los criterios para diagnosticar ITS no son uniformes, por lo que el Pap no debe usarse en lugar de una prueba diagnóstica más efectiva y el tratamiento no debe basarse en los hallazgos citológicos.
Palabras clave: Tinción de Papanicolaou, Diagnóstico, Vaginosis bacteriana, Tricomoniasis, Candidiasis, Transmisión sexual
Abstract
Objective
We undertook this study to assess the validity of cytologic diagnosis of sexually transmitted infections like: bacterial vaginosis (BV), tricomoniasis and candidiasis using the Papanicolaou (Pap) smear.
Design
Prospective, descriptive transverse study.
Setting
The present study was carried out in the Health Center Dr. José Castro Villagrana in Tlalpan, México, D.F. from January 1997, to February 2000.
Participants
Routine Pap smears and vaginal secretion smears were collected from two hundred and seventy one patients ranged from age 16–66 years, with cervicovaginitis diagnosis.
Measurements and main results
Of the 271 patients, 92 (33.9%) had bacterial vaginosis diagnosed by Amsel criteria, 47 (17.3%) had candidiasis by culture and 5 (1.8%) had tricomoniasis by wet smear. The Bethesda system for diagnosing BV on Pap smear had 66% sensitivity and a specificity of 86%. The respective positive predictive and negative predictive value were 79% and 84%. Therefore, compared to the Candida culture, cervical cytologic test results had a sensitivity of 21% and specificity of 99%. The predictive positive predictive and negative predictive values were 90% and 85%.
Conclusions
Specificity tended to be higher than sensitivity, in other words cytology tended to be more efficent in identifying women without sexually transmitted infection than in identifying those with infection. In summary, the Pap smear should not be used in lieu of more effective diagnostic test for sexually transmitted disease, and treatment should not be based on cytologic findings alone.
Key words: Papanicolaou smear, Diagnosing, Bacterial vaginosis, Tricomoniasis, Candidiasis, Sexual transmitted infections
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