7
Microbiology, inflammation, and Viral infections
Fig. 7.42 “Early" herpes genitalis infection.
Vaginopancervical smear
(Papanicolaou x HP).
Fig. 7.44 Bizarre columnar cells
in a smear with herpes genitalis infection.
LBGS (Papanicolaou x HP).
Fig. 7.43 Herpes genitalis infection.
Vaginopancervical smear
(Papanicolaou x HP).
Fig. 7.45 Herpes genitalis.
Note both intranuclear inclusions and ‘ground-
glass' nuclei in the same group of cells. LBGS (Papanicolaou x MP).
or degenerated and may be misinterpreted as tumor cells. The
cytoplasm may show changes of the cytoskeletal structure and
become dense or opaque uniformly or focally. The latter may
represent keratohyaline material. Degenerative vacuoles, the
ectoplasmic-endoplasmic differentiation with spiral fibrils of
Erbeth, as described by Patten,67 may be present between the
two zones. The fibrillary apparatus of Herxheimer appears as
delicate, uniformly thin spirals that originate at the nucleus,
travel down the cytoplasm, and may be observed in cells with
squamous differentiation features.
Key features of herpes genitalis infection
Multinucleated giant cells not diagnostic;
Nuclear changes critical for diagnosis; and
Primary and secondary infection cannot be distin-
guished morphologically.
Multinucleated giant cells per se do not establish the diag-
nosis of HSV infection. Proper nuclear features and inclusions
must be identified for such diagnosis. Virus-infected cells or
virocytes should be distinguished from other giant cells such
as trophoblasts, foreign-body giant cells following extraneous
intervention with foreign bodies or surgery, nonspecific giant
cells seen in postmenopausal smears, and reactive multinucle-
ated cells found in cases of cervicitis.
Some workers have described morphologic differences that
may distinguish between primary and recurrent herpes. Paucity
of intranuclear inclusions and occurrence of chromatin homo-
geneity and "ground-glass" changes were often reported in
primary herpes, whereas inclusions were predominant among
cases with post primary infection. The studies of Vesterinen and
associates63 and other workers have not confirmed this obser-
vation, although the World Health Organization has adapted
these observations differentiating primary and recurrent herpes.
Morphologically, HSV 2 and HSV 1 cannot be differentiated.
Either such diagnosis can be rendered only by appropriate sero-
logic reactions or viral culture studies (Fig. 7.45).
Cytomegalovirus
These large (1800-2000 A) DNA viruses belong to the herpes
group that includes HSV 1, HSV 2, varicella-zoster, and EB virus.
CMV is ubiquitous and circulates commonly in the general
population. As with herpes viruses, CMV establishes itself in the
host and causes persistent infection and recurrent disease. In the
genital tract, reinfection may occasionally occur. Unlike other
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