Spectrum and Prevalence of Infections Detected in Liquid-based Cytology of Cervical Smears

Pap smear is a universally accepted screening test for early diagnosis of premalignant and malignant cervical lesions. Most studies show inflammation as the most common finding in Pap screening. Cervical infections frequently lead to inflammation and pose significant clinical implications due to their potential to manifest as infertility, pelvic inflammatory disease, and pregnancy-related complications such as chorioamnionitis.

A prospective analysis of 3230 cervical liquid-based cytology smears collected during January 2017 to June 2018 was undertaken to identify prevalent infection types in cervical smears in a North Indian population catered at tertiary care hospital.

A total of 2303 (71.3%) cases screened were in the age group of 21-40 years with a median age of 35.7 years. Totally 25.1% of cases had infection, of which the most common was bacterial vaginosis (BV) (58.07%), followed by Candida (20.34%), human papillomavirus-related changes (11.34%), and Trichomonas vaginalis (9.5%). Rare cases of herpes simplex virus, tuberculosis, and microfilaria were also reported. A total of 24 (5.09%) cases of BV had coexistent low-grade squamous intra-epithelial lesion as compared to 447 (94.9%) cases with BV alone (odds ratio = 0.77; 95% confidence interval: 0.4949-1.1877; P = 0.2342), suggesting an association between the two; however, it was insignificant.

Cervical cancer screening program for early detection of cervical neoplasia has efficiently led to a significant reduction in the incidence of cervical cancer worldwide. Notably, early detection and treatment of infectious lesions in cervix have also helped in reducing complications related to various infections. BV is recognized as the most common vaginal infection, and its association with cervical preneoplasia, as shown by recent studies, is being viewed as a possible etiology behind cervical neoplasia and needs to be explored through further research.