The pathogenic microorganisms in papanicolaou vaginal smears and correlation with inflammation.

  • Esmat Barouti Infertility and Reproductive Health Research Center, Department of Obstetrics and Gynecology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Farah Farzaneh Infertility and Reproductive Health Research Center, Department of Obstetrics and Gynecology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Azadeh Akbari Sene Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Tehran, Iran.
  • Zohreh Tajik Infertility and Reproductive Health Research Center, Department of Obstetrics and Gynecology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Bahar Jafari Department of Pathology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Bacterial vaginosis, Inflammation, Pap smear, Trichomonas vaginalis, Vaginal candidiasis


Objective: Non-specific cervicitis or inflammatory changes in a smear report are common which are usually unclear for clinical approaches. To investigate the frequency of inflammation and pathogenic vaginal microorganisms in cervical smears among an Iranian population sample.Materials and methods: This cross-sectional study was carried out on Pap smear samples of women referred to gynecological clinic of Taleghani Hospital in Tehran, Iran, between October 2008 and March 2009. This study was conducted on 528 conventional Papanicolaou cervical smears. The frequency and severity of inflammation and prevalence of bacterial vaginosis (BV), Trichomonas vaginalis (TV), and vaginal candidiasis (VC) was determined in the samples. Also co-infection of the microorganisms in Pap samples was evaluated. percentage, mean±standard deviation of the outcome parameters were calculated. The comparison between data was performed with the Pearson's chi square or Fisher's exact test.Results: The prevalence of BV, VC, and TV in Pap samples was 17%, 11%, and 0.4% respectively. Overall, the prevalence of these microorganisms in women of reproductive age was higher than menopausal women. There was a significant association between VC and the presence of inflammation in our samples.Conclusion: Based on our results, inflammation in the Pap smears can suggest an infection of VC and the patients should be considered for proper VC treatment.


Owen MK, Clenney TL. Management of vaginitis. Am Fam Physician 2004; 70:2125-32.

Heller DS, Maslyak S, Skurnick J. Is the presence of trichomonas on a pap smear associated with an increased incidence of bacterial vaginosis? J Low Genit Tract Dis 2006; 10:137-9.

Azargoon A, Darvishzadeh S. Association of bacterial vaginosis, trichomonas vaginalis, and vaginal acidity with outcome of pregnancy. Arch Iran Med 2006;9:213-17.

Brown D. Clinical variability of bacterial vaginosis and trichomoniasis. J Reprod Med 2004;49:781-6.

Cauci S, Culhane JF. Modulation of vaginal immune response among pregnant women with bacterial vaginosis by trichomonas vaginalis, chlamydia trachomatis, neisseria gonorrhoeae, and yeast. Am J Obstet Gynecol 2007; 196:133 e1-7.

Cotch MF, Pastorek JG 2nd, Nugent RP, Hillier SL, Gibbs RS, Martin DH, et al. Trichomonas vaginalis associated with low birth weight and preterm delivery. The vaginal infections and prematurity study group. Sex Transm Dis 1997; 24:353-60.

Platz-Christensen JJ, Larsson PG, Sundstrom E, Wiqvist N. Detection of bacterial vaginosis in wet mount, papanicolaou stained vaginal smears and in gram stained smears. Acta Obstet Gynecol Scand 1995; 74:67-70.

Loo SK, Tang WY, Lo KK. Clinical significance of trichomonas vaginalis detected in papanicolaou smear: A survey in female social hygiene clinic. Hong Kong Med J 2009; 15:90-3.

Demirezen S, Korkmaz E, Beksac MS. Association between trichomoniasis and bacterial vaginosis: Examination of 600 cervicovaginal smears. Cent Eur J Public Health 2005; 13:96-8.

Myer L, Denny L, Telerant R, Souza M, Wright TC Jr, Kuhn L. Bacterial vaginosis and susceptibility to hiv infection in south african women: A nested case-control study. J Infect Dis 2005; 192:1372-80.

Shobeiri F, Nazari M. A prospective study of genital infections in hamedan, iran. Southeast Asian J Trop Med Public Health 2006; 37 Suppl 3:174-7.

Madhivanan P, Krupp K, Chandrasekaran V, Karat C, Arun A, Cohen CR, et al. Prevalence and correlates of bacterial vaginosis among young women of reproductive age in mysore, india. Indian J Med Microbiol 2008; 26:132-7.

Romoren M, Velauthapillai M, Rahman M, Sundby J, Klouman E, Hjortdahl P. Trichomoniasis and bacterial vaginosis in pregnancy: Inadequately managed with the syndromic approach. Bull World Health Organ 2007; 85:297-304.

Tchoudomirova K, Bassiri M, Savova J, Hellberg D, Mardh PA. Gynaecological and microbiological findings in women attending for a general health check-up. J Obstet Gynaecol 1998; 18:556-60.

Depuydt CE, Leuridan E, Van Damme P, Bogers J, Vereecken AJ, Donders GG. Epidemiology of trichomonas vaginalis and human papillomavirus infection detected by real-time pcr in flanders. Gynecol Obstet Invest 2010; 70:273-80.

Madhivanan P, Bartman MT, Pasutti L, Krupp K, Arun A, Reingold AL, et al. Prevalence of trichomonasvaginalis infection among young reproductive age women in india: Implications for treatment and prevention. Sex Health 2009; 6:339-44.

Saturnino AC, Sisenando HA, Pereira AR, Vale AP, Pires LM, de Araujo JT, et al. [vulvovaginitis: Vaginal ph changes and associated microflora]. Acta Cir Bras 2005; 20 Suppl 1:266-9.

Rendon-Maldonado JG, Espinosa-Cantellano M, Gonzalez-Robles A, Martinez-Palomo A. Trichomonas vaginalis: In vitro phagocytosis of lactobacilli, vaginal epithelial cells, leukocytes, and erythrocytes. Exp Parasitol 1998; 89:241-50.

Torok MR, Miller WC, Hobbs MM, Macdonald PD, Leone PA, Schwebke JR, et al. The association between trichomonas vaginalis infection and level of vaginal lactobacilli, in nonpregnant women. J Infect Dis 2007; 196:1102-7.

Ayres de Campos D, Nogueira A, Magalhaes F, Bayer

P, Monteiro J, Lameirao A, et al. [inflammatory smears in cervicovaginal cytology. A finding meaning infection?]. Acta Med Port 1997; 10:637-41.

Bertolino JG, Rangel JE, Blake RL Jr, Silverstein D, Ingram E. Inflammation on the cervical papanicolaou smear: The predictive value for infection in asymptomatic women. Fam Med 1992; 24:447-52.

Burke C, Hickey K. Inflammatory smears--is there a correlation between microbiology and cytology findings? Ir Med J 2004; 97:295-6.

Singh V, Gupta MM, Satyanarayana L, Parashari A, Sehgal A, Chattopadhya D, et al. Association between reproductive tract infections and cervical inflammatory epithelial changes. Sex Transm Dis 1995; 22:25-30.

Wang PD, Lin RS. Epidemiologic differences between candidial and trichomonal infections as detected in cytologic smears in taiwan.Public Health 1995; 109:443-50.

How to Cite
Barouti E, Farzaneh F, Sene AA, Tajik Z, Jafari B. The pathogenic microorganisms in papanicolaou vaginal smears and correlation with inflammation. J Fam Reprod Health. 7(1):23-7.
Original Articles