THE INFLAMMATORY PAPANICOLAOU SMEAR - WHAT DOES IT MEAN

Objective: To determine the correlation between inflammation detected on Papanicolaou smear and specific lower genital tract agents, and, ba sed on these findings, to develop recommendations for follow-up tests and treatment of young women with inflammation on smears. Methods: A h igh-risk population of 779 randomly selected women attending a sexuall y transmitted disease (STD) clinic and a low-risk population of 1050 c onsecutive women presenting for annual examination at a university stu dent health center underwent a standardized history and gynecologic ex amination. Univariate and multivariate analyses, focusing on the assoc iation between dense inflammation on Papanicolaou smear and specific l ower genital tract pathogens or findings on cervical examination, were done for each population. Results: Dense inflammation was present on the Papanicolaou smear of 255 (33%) of the 779 women in the STD clinic and 200 (19%) of 1050 students. Dense inflammation on Papanicolaou sm ear was independently associated with mucopus, cervical ectopy, cervic al infection with Neisseria gonorrhoeae, Chlamydia trachomatis, herpes simplex virus (HSV), and vaginal infection by Trichomonas vaginalis i n the STD population; in the student population, it was associated wit h cervical ectopy, C trachomatis, and mucopus. Conclusion: Although de nse inflammation on Papanicolaou smear was a common finding in both th e high- and low-risk populations, about half of the inflammation detec ted in the high-risk setting was associated with a specific microbial organism (C trachomatis, N gonorrhoeae, HSV, or T vaginalis), whereas less than 10% of the dense inflammation detected in the low-risk setti ng was linked with a specific pathogen (C trachomatis). In both settin gs, a substantial population of sexually active women had dense inflam mation associated with cervical ectopy but none of the specific organi sms evaluated in this study.