Genital herpes diagnosed by cervical cytology

Sir, The cervix is commonly affected by first attacks ofgenital herpes, but much less often by recurrences.' The definitive method of diagnosing genital herpes is by growing the virus in tissue culture.2 Cells obtained from the cervix by exfoliative cytology, however, may show changes characteristic of herpes simplex virus (HSV) infection. These features consist of the homogenisation of nuclear contents, margination of chromatin leading to a "ground glass" appearance, multinucleation leading to the formation of giant cells, and the presence of intranuclear eosinophilic inclusions.3 HSV infection is only rarely detected on cervical cytology. A study in Atlanta, United States of America, showed features of HSV in only 0-16% of 40 000 smears,3 and a similar result was obtained in an analysis of over 57 000 cervical smears in Finland.4 We carried out this study to assess the clinical characteristics of patients in whom HSV was detected on routine cervical cytology. The case notes of all women attending the department of genitourinary medicine at the Middlesex Hospital during a two year period whose cervical smears showed changes characteristic of HSV were analysed retrospectively. We noted any history of genital herpes and the presence of herpetic lesions and of any coexisting sexually transmitted disease (STD). Differences were compared using Fisher's exact test. We found 30 women with genital herpes. In 21 it was suspected at the initial visit, material for viral culture was obtained from the cervices of 20 of them, and all cultures gave positive results. In the remaining nine women genital herpes was not suspected, and viral cultures had not been performed at the initial clinic visit. Material for viral cultures was obtained two weeks later from five, and all gave negative results. Sixteen of the 30 women had one or more genital infection in addition to HSV. The cervices appeared abnormal in 19 (63%) of the women, although the appearances in women in whom herpes was suspected were similar to the appearances in women in whom it was not suspected (table). Table Appearance ofcervices of30 women infected with herpes simplex virus (HSV) (figures are numbers (percentages) of women with given abnormality)