Studies related to the significance of the occurrence of clue cells in cervico-vaginal smears.

A total of 8824 cervico-vaginal smears were examined for frequency of occurrence of clue cells, and the relationship between number of polymorphonuclear leukocytes, distribution of age and menstrual cycle was also investigated.<BR>In this study clue cells were observed in 300 (3.4%) of the 8824 cases, in 15.4% of those in the 2nd decade, 7.2% of those in the 3rd decade, 2.7% of those in the 4th decade, 4.5% of those in the 5th decade, 2.0% of those in the 6th decade and in 0.3% of those over 60 years old, with the frequency of occurrence varying inversely with age. However, no seasonal changes in the frequency of occurrence were observed.<BR>The frequency of occurrence of clue cells according to Papanicolaou's classification was higher in class III (13.5%) and IV (20.0%) than in class I (2.9%) or II (4.0%). Koilocytes suggesting human papilloma virus infection were observed in 14 of the 28 cases (50.0%) of dysplasia which exhibited clue cells.<BR>The numbers of polymorphonuclear leukocyte on smears on which clue cells were detected were divided into four categorics: completely absent (10.3%), one plus (68.7%), two plus (17.3%) and three plus (3.7%). Only 21.0% exhibited inflammatory change.<BR>Clue cells were observed highly more frequently in the first half of the menstrual cycle (13.1%) in the menstrual phase and 63.7% in the proliferative phase than in the secretory phase (23.2%), suggesting that there is some relationship between hormones and G. vaginalis.<BR>Based on the results of this study, we do not think that G. vaginalis infection is a sexually transmitted disease, but think that it should be considered related to the sexual behavior of women. Furthermore, the occurrence of clue cells is not only useful in the diagnosis of bacterial vaginosis (BV) but shoud be also regarded as a “latent period” of BV, and should be reported to the gynecologist regardless of their numbers because of the abnormality of the bacterial flora.