Papanicolaou Test in Women with Abnormal Bacteriologic Exam Results

The normal vaginal flora is complex and includes various organisms, many of them conditioned pathogens. The vaginal microbiome is controlled by estrogens that is why a major difference it encountered between pre-menopausal and menopausal women. Bacterial vaginosis was associated with inflammatory changes on Papanicolaou (PAP) smears and chronic inflammation may eventually tead to potentially precancerous and cancerous processes of the cervix. We asses the importance of PAP test and early discovery of vaginal infections because bacterial vaginosis has been associated with inflammatory changes on PAP smears.

Materials and metods: Were analysed 50 patients with bacteriologic exam and PAP smear, from ambulatory (Polyclinic Constanța). Bacteriological exam was performed on smears stained Gram from vaginal secretion, collected during the same ginecological examination when PAP smears were collected. The PAP smear was conventional PAP. Samples were obtained by cervical brushing.

Results and discussions: These patients were aged between 21 and 64 year and were examined for various symptoms. The patients were classified in pre-menopausal 35% and post-menopausal 65%.The result of the bacteriologic exam showed normal flora (absence of infection) in 44% of cases and abnormal vaginal flora in 56% of the cases.

The predominant pathology was bacterial vaginosis with non-specific flora (Gram positive coci and Gram negative bacilli, absence of lactobacilli) in 38% of cases. Candida infection was present in 12% of the cases and Trichomonas vaginalis and Actynomices in 3% of the cases each.

Conclusions The majority of patients with bacterial vaginosis (Candida, Trichomonas,Actinomyces) had Pap tests negative for intraepithelial lesion or malignancies NILM or NILM and cellular changes associated with inflammation. There may be infectious causes of abnormal Pap tests other than HPV.