Prevalence of Infectious Organisms Observed in Cervical Smears Between 1997–2014 at Mubarak Al-Kabeer Hospital, Kuwait

Objectives: This study aimed to examine gynaecological infectious agents observed in conventional and modified Papanicolaou cervical smears (CS) at a tertiary care hospital in Kuwait. Methods: This retrospective study analysed 121,443 satisfactory CS samples collected between 1997–2014 at the Mubarak Al-Kabeer Hospital, Kuwait. Conventional CS samples were obtained between 1997–2005, while modified CS were obtained between 2006–2014 following the introduction of ThinPrep ® testing (Hologic Corp., Bedford, Massachusetts, USA). All samples were initially screened by cytoscreeners before being analysed by cytopathologists to determine the presence of specific infectious agents. Results: Overall, 8,836 (7.28%) of the cervical samples had infectious agents; of these, 62.48% were conventional and 37.52% were modified CS samples. The most frequently observed infectious agents were Candida  species (76.05%), Trichomonas vaginalis (9.72%), human papillomavirus (HPV; 9.3%), Actinomyces -like organisms (3.23%), Chlamydia trachomatis (1.27%) and the herpes simplex virus (HSV; 0.43%). There were significantly more cases of Candida species, HPV-associated changes, C. trachomatis , T. vaginalis and Actinomyces -like organisms detected in conventional compared to modified CS samples ( P <0.050 each). However, there was no statistically significant difference in the frequency of HSV-associated changes ( P = 0.938). The presence of two infectious agents in the same sample was identified in 0.87% of samples. Conclusion: Among CS samples collected during an 18-year period,  Candida species were most frequently detected, followed by T. vaginalis and HPV. The identification of potential infectious agents is a valuable additional benefit of Papanicolaou smear testing. Keywords: Cervical Smears; Papanicolaou Test; Infection; Candida; Trichomonas vaginalis; Human Papilloma Virus; Cytology; Kuwait.