Vaginal pH as a Simple Adjunct to Pap Smear for the Screening of Bacterial Vaginonsis and Candidiasis : A Prospective Observational Study

Abstract

Background: Vaginal infections remain a common reason for gynecology visits, and a quick, inexpensive bedside
marker that correlates with cytological diagnosis would be clinically useful. Vaginal pH is known to vary with
vaginal flora, and elevated pH is classically associated with bacterial vaginosis, while candidiasis often occurs with
near-normal pH in many cases.
Objectives: To evaluate the association between vaginal pH (continuous and categorized) and Pap smear–based
cytological diagnosis (normal/BV/candidiasis) in women.
Methods: This prospective observational study screened 72 women; 12 were excluded (reasons detailed in
Methods), and 60 participants were included in the final analysis. Vaginal pH was recorded and categorized (≤4.5,
4.6–5.5, >5.5). Pap smear report was categorized as normal, bacterial vaginosis (BV), or candidiasis. Associations
were assessed using chi-square testing with effect size estimation.
Results: Among 60 participants, Pap smear reports were normal in 42 (70.0%), candidiasis in 10 (16.7%), and BV in
8 (13.3%). Vaginal pH category showed a strong association with Pap smear category Candidiasis clustered
predominantly in the ≤4.5 pH group, while BV clustered predominantly in the >5.5 group.
Conclusion:Vaginal pH demonstrated a strong association with Pap smear–based cytological screening of
vaginitis in women who were also screened for premalignant conditions using pap smear and may serve as a
simple adjunct marker in routine clinical assessment.