Clinicopathological Study of Papanicolaou (Pap) Smears for Diagnosing of Cervical Infections Mulazim Hussain Bukhari, M.B.B.S., F.C.P.S.,Ph.D., 1 * Mudassar Majeed, M.B.B.S., F.C.P.S., 1 Samina Qamar, M.B.B.S., F.C.P.S., 1 Shahida Niazi, M.B.B.S., M.Phil., 1 Sadaf Zahra Syed, M.B.B.S., M.C.P.S.,F.C.P.S., 2 Ahmed Wasim Yusuf, M.B.B.S., M.C.P.S., M.S., 2 and Noshin Wasim Yusuf, M.B.B.S., M.R.C.Path., F.R.C.Path. 3 Cervical infections are not uncommon in our population espe- cially in young and sexually active women. One thousand sam- ples of married women, aged between 20 and 70 years, were studied by conventional Papanicolaou smears. These samples were examined in the Department of Pathology, King Edward Medical University, Lahore from January 2007 to June 2009. Only cases without (pre)neoplastic cytology were included. Six types of infections were diagnosed cytologically. The overall fre- quency of normal, inadequate, neoplastic, and infective smears was 50%, 1.8%, 10.2%, and 38.3%, respectively. Most of the patients (67%) were in the reproductive age group with mean age 34.7 6 2.6 years. The commonest clinical sign seen in 354/ 383 (92%) cases and symptom in (349/383; 91%) cases were vaginal discharge and pruritis vulvae. Among the infective smears, 290 cases (75.7%), the cytologic diagnosis was nonspe- cific inflammation. Most of these 290 smears contained clue cells (indicating Gardnerella infection) and a lack of lactobacilli. Such smears are predominant in patients suffering from bacte- rial vaginosis (BV). Twenty-eight smears (7.3%) were positive for Trichomonas vaginalis, 27 cases (7%) were smears with koi- locytic change pathognomonic of human papilloma virus infec- tion. Twenty-five smears (6.5%) were positive for fungal infec- tion. Seven cases (1.8%) were diagnosed as herpes simplex virus infection. Finally, there were six cases (1.5%) with atrophic vaginitis. We conclude that the cervical smear is well suited for diagnosing cervical infections. It is clear that Gardnerella, known to be associated with bacterial vaginosis, is a major problem in our Pakistani population. Diagn. Cytopathol. 2012;40:35–41. ' 2010 Wiley Periodicals, Inc. Key Words: Papanicolaou; herpes simplex; fungal infections; human papilloma virus; Trichomonas vaginalis; Gardnerella Cervical infections are common problems in women of reproductive age group that incurs a substantial cost and are associated with the clinical complaints of vaginal dis- charge, odor, and pruritis. 1–3 In most infections, lactoba- cilli are absent or greatly reduced. 4,5 The Pap smear is a screening test performed on cells from the uterine cervix. 6–8 The Pap test was introduced as a cervical screening test in 1943 by George Papanicolaou for whom it is named. A Pap test is simple, quick, pain- less procedure. While a woman lies on an examination ta- ble, the clinician inserts a speculum into her vagina to open it. To perform the test, a sample of cells is taken from in and around the cervix with a wooden scraper and placed on a glass slide and rinsed in liquid fixative and sent to a laboratory for examination. 9–12 The study was conducted to see the Role of Papanico- laou Pap in the diagnosis of Non Neoplastic Gynecologi- cal Diseases. The study was conducted to see the Role of Papanico- laou Pap in the diagnosis of cervical infections. Materials and Methods Cross-sectional studies on married women aged between 20 and 70 years were carried out through hospital-based sampling. One thousand pap smears were analyzed in the Department of Pathology, King Edward Medical Univer- sity, Lahore, Pakistan. Patients presenting with complaints of vaginal dis- charge, backache, pain hypogastrium, dyspareunia, dysu- ria, and postcoital bleeding were included. Patients having vaginal bleeding, other than postcoital, were excluded from the study. The history of the patients was taken and 1 Department of Pathology, King Edward Medical University, Lahore, Pakistan 2 Department of Gynecology and Obstetrics, Lady Walingdon Hospital, Lahore, Pakistan 3 Department of Pathology, Allama Iqbal Medical College, Lahore, Pakistan *Correspondence to: Mulazim Hussain Bukhari, M.B.B.S., F.C.P.S., Ph.D., King Edward Medical University, Lahore, Pakistan. E-mail: drmhbukhari@yahoo.com Received 1 March 2010; Accepted 11 June 2010 DOI 10.1002/dc.21498 Published online 14 October 2010 in Wiley Online Library (wileyonlinelibrary.com). ' 2010 WILEY PERIODICALS, INC. Diagnostic Cytopathology, Vol 40, No 1 35