PAPANICOLAOU SMEAR ABNORMALITIES IN REPRODUCTIVE AGE WOMEN: A CROSS-SECTIONAL STUDY ON CLINICAL IMPLICATIONS
DOI:
https://doi.org/10.22159/ajpcr.2025v18i12.57329Keywords:
Cervical cytology, Pap smear, Vaginal discharge, Bethesda system, Epithelial abnormalities, Reproductive-age women, IndiaAbstract
Objectives: To delineate the spectrum of Papanicolaou (Pap) smear abnormalities in reproductive-age women attending a South Indian tertiary center and to correlate Bethesda categories with presenting symptoms, particularly patterns of vaginal discharge.
Methods: This cross-sectional descriptive study included 1,800 consecutive women aged 20–50 years who underwent clinically indicated Pap testing from June 2024 to May 2025. Conventional cervical smears were collected, stained with Pap, and reported as per the 2014 Bethesda System. Demographic data, symptom profile, and examination findings were recorded on a structured requisition. Cytology findings were summarized as frequencies and proportions, and clinicocytologic associations and age-stratified patterns were analyzed using appropriate statistical tests.
Results: Most women presented with white vaginal discharge (95.8%), followed by greenish-white frothy discharge (3.7%) and contact bleeding with low back pain and an unhealthy cervix (0.5%). Cytology was predominantly non-neoplastic: Non-specific inflammation constituted 85.3% of smears, while organism-associated infections accounted for 10.8% (candidiasis 3.9%, trichomoniasis 3.6%, and bacterial vaginosis 3.3%). Epithelial abnormalities were detected in 3.9% of smears (atypical squamous cells of undetermined significance 1.5%, low-grade squamous intraepithelial lesion 1.1%, high-grade squamous intraepithelial lesion [HSIL] 0.7%, and malignancy 0.6%). Curdy white discharge is mapped chiefly to candidiasis, frothy discharge to trichomonas, and leukorrhea with cervical erosion to bacterial vaginosis. High-grade lesions and malignancies clustered in women aged 40–50 years, who contributed 60% of all epithelial abnormalities and 80% of malignancies.
Conclusion: In symptomatic reproductive-age women, Pap smears are largely inflammatory yet still reveal a clinically important burden of HSIL and malignancy, particularly among women in their forties with contact bleeding and an unhealthy cervix. These findings emphasize the dual role of conventional cytology in detecting infections and epithelial atypia and support strengthening opportunistic, symptom-linked Pap screening within gynecology outpatient settings in similar South Asian contexts.
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