Benign cellular changes

1. Infection--candida. Most cases represent asymptomatic colonization. Treatment should be offered for symptomatic cases. The Pap should be repeated at the usual interval.

2. Infection-Trichomonas. If wet preparation is positive, treat with metronidazole (Flagyl), then continue annual Pap smears.

3. Infection-predominance of coccobacilli consistent with shift in vaginal flora. This finding implies bacterial vaginosis, but it is a non-specific finding. Diagnosis should be confirmed by findings of a homogeneous vaginal discharge, positive amine test, and clue cells on saline suspension.

4. Infection-herpes simplex virus Pap smear has a poor sensitivity, but good specificity, for HSV. Positive smears usually are caused by asymptomatic infection. The patient should be informed of pregnancy risks and the possibility of transmi ssion. Treatment is not necessary, and the Pap should be repeated as for a benign result.

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