1. Infection—Candida. Most cases represent asymptomatic colonization. Treatment is offered for symptomatic cases. The Pap should be repeated at 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 nonspecific 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 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 transmission. No treatment is necessary, and the Pap should be repeated as for a benign result.
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