Acute cervicitis and vulvovaginitis may be associated with Cytomegalovirus

Abstract

Cytomegalovirus (CMV) infection in immunocompetent hosts is generally asymptomatic or may present as a mononucleosic syndrome. Its association with acute cervicitis and vulvovaginitis has rarely been reported. A 24-year-old woman presented with pelvic pain, vulvodynia, abnormal vaginal discharge, burning with urination, fatigue, fever, vomiting and diarrhoea. The vulva and cervix were red with vesicular lesions on the cervix. Genital herpes simplex infection (HSV) was suspected and valacyclovir was given orally. However, serial viral cultures performed 7 weeks apart did not isolate HSV as suspected, but CMV was confirmed by immunofluorescence and early antigen research. Blood tests confirmed an acute CMV infection. Typical inclusions were found at histology. Symptoms resolved slowly with persistence of cervical lesions at 7 weeks from diagnosis. The frequency of CMV genital infection is probably underestimated. The infection is not always asymptomatic and might be confused with genital HSV infection. The clinical course is longer.

Cytomegalovirus (CMV) in cervical cancer screening tests: A series of 8 cases and review of the literature

“…Four cases in our series had immune‐affecting conditions, such as tuberculosis exposure, diabetes and/or obesity . Nine papers reported detection of CMV in patient with competent immune systems, which was represented in three of our cases. We observed that there appeared to be a seasonal expression of CMV in our case series, mostly occurring in the fall and winter months (6 of 8 cases; 75%), notably in January (2/8; 25%).…”

“…Including this case series, the previous case reports described findings of CMV in 48 patients. Eighteen patients had changes of CMV reported in surgical pathology specimens There were twenty cases reported in conventional pap smears, nine were detected in Surepath liquid‐based preparation, and one in ThinPrep liquid‐based preparation(Hologic, Marlborough, MA) . Of the thirty patients reported in cytology specimens, the patients' age ranged from 13 to 50 years, average of 27 years, and median of 24 years.…”

“…CMV in the FGT were most commonly reported in patients with immune system deficits, including HIV/AIDS, transplant patients, prior cancers, history of HPV infection, proximal to pregnancy, and immunity‐affecting conditions, such as autoimmune disease, obesity and diabetes, similar to those reported in our current case series. Nine papers report CMV detected in immune‐competent patients …”

“…CMV may cause significant congenital defects that may occur during birth and is linked to a number of conditions and diseases, such as diabetes and autoimmune conditions . CMV viremia and virus shedding is often found in vaginal samples of healthy women but detection of cellular changes of CMV infection in the female genital tract (FGT) is more unusual …”

Protocolos y manejo práctico de pacientes con secreción uretral o vaginal patológica

“…Agentes víricos como virus herpes simple, citomegalovirus, adenovirus o el virus del papiloma humano pueden estar asimismo directa o indirectamente involucrados en un cuadro de cervicitis 25,35,36 .…”