Incidence and Cytomorphological Peculiarities of Lower Genital Tract Infections in Vault (Post Hysterectomy) Smears Versus Pap Smears from Non-Hysterectomy Subjects: A Retrospective Study

Abstract

To evaluate morphology and frequency of lower genital infections in (post hysterectomy) vault smears of women. We analyzed vault smears from 500 women who had undergone hysterectomy, either for benign diseases (230) or for carcinoma cervix (270) and findings were compared with Pap smear diagnosis of non-hysterectomy subjects. Majority 432/500 (87%) of the vault smears were negative for squamous abnormality in comparison to 381/500 (76%) Pap smears from non-hysterectomy subjects. It was observed that 48 (9.6%) vault smears showed lower genital tract infections, however frequency of infections was reported significantly higher 101 (20.2%) in non-hysterectomy subjects. Gardenerella vaginalis was the leading infection in vault smears 26 (5.2%) due to benign diseases and was prevalent in the fifth and sixth decades of life of women in comparison to 43 (8.2%) in Pap smears with higher prevalence in the fourth decade of life. Trichomonas vaginalis and Human Papillomavirus infection were the second commonest infections in vault smears followed by Candida albicans. Cytologically diagnosed gynecological infections were remarkably low 48 (9.6%) in vault smears as compared to 101/500 (20.2%) amongst non-hysterectomy subjects. Infections which mainly thrive at the Squamo-columnar junction i.e. HPV, Chlamydia and HSV were absent or rare in vault smears. Further incidence of infections in the vault smears where hysterectomy was done due to carcinoma cervix was as low as 10 (3.7%) as compared to 38 (16.5%) where hysterectomy was done due to benign uterine diseases.