Sensitivity of a papanicolaou smear in the diagnosis of candida albicans infection of the cervix

Background: Candida albicans infections of the cervix are not adequately diagnosed in Papanicolaou smears when compared with culture in Sabouraud dextrose agar.

Methods: Cervical smears were collected from 1000, non-pregnant, asymptomatic women. The specimens were prepared using the Papanicolaou (Pap) smear method examined by microscopy and subsequently cultured in Sabouraud dextrose agar.

Results: The overall incidences of C. albicans in cervical smears cultured in Sabouraud dextrose agar was 30.10%, while the incidence in the Pap smears was 7.60%, making the sensitivity of Pap smears for the diagnosis of C. albicans to be 25.25%. Mild, and some moderate, infections detectable in Sabouraud dextrose agar could not be detected in the Pap smear specimens. Vulnerability to C. albicans infection decreased with age, the highest infection rate being between 20 and 39 years of age while the least was between 60 and 69 years of age. Papanicolaou's method stained the nuclei, chromatin and nucleoli very well and enhanced differentiation between malignant and non-malignant cells. It also stained the cytoplasm and its contents such as keratin, vacuoles and granules and differentiated between acidophilic and basophilic materials. Non-cellular substances such as fibrin, crystals and pigments were also stained using this method. In addition, Papanicolaou's method also stained some fungal and bacterial species, but did not provide differential staining characteristics seen in Gram staining technique.

Conclusions: Papanicolaou stain should not be used as an alternative to culture in the diagnosis of Candida albicans.