Detection of chlamydial cervicitis by Papanicolaou stained smears and culture

The ability of the cervical Papanicolaou (Pap) smear to detect cervicitis associated with Chlamydia trachomatis was investigated. Cultures and cervical cytology samples were obtained from 487 women seen at the Mayo Clinic Department of Obstetrics and Gynecology and at the Sexually Transmitted Disease clinic of the Olmsted County Health Department. Adequate pap smears contained endocervical or metaplastic cells. Thirty-seven patients had positive Chlamydia cultures; of these, 14 were cytologically suggestive of Chlamydia, 10 were negative but satisfactory, and 13 were unsatisfactory. Of the 450 patients with negative cultures, 21 had cytologic findings suggesting infection. Thus, of 35 cases suggestive cytologically, 14 (40%) were confirmed by culture. Of the 21 false-positive cytologies, eight were in postpartum women. Because of problems with specificity and inadequate smears, cervical cytology specimens should not replace culture as a means of detection, but can identify women who should be cultured for C. trachomatis.