The Relationship of Vaginal Symptoms and Cervical Inflammation Severity with Cytological Abnormalities and HPV Positivity: A Prospective Observational Study

Background/Objectives: This study aimed to evaluate the association between the clinical parameters of vaginal infection—specifically the presence, type, number of concurrent symptoms, and recurrence frequency—and cervical cytology findings, including inflammation severity, Candida, bacterial vaginosis, cellular abnormalities, and Human Papillomavirus (HPV) positivity. Methods: This prospective, cross-sectional, observational study included 458 women attending our gynecology outpatient clinic for Pap smear screening. Vaginal symptoms were documented through face-to-face interviews using a structured data collection form. Cervical samples were evaluated via liquid-based cytology by a single, experienced cytopathologist, who was blinded to the clinical data; cellular abnormalities, the degree of inflammation and cytomorphological findings indicative of infection were reported. HPV analysis was performed on the 218 women for whom results were available. Chi-square and trend chi-square tests were used in the statistical analysis. Results: No significant association was found between the clinical parameters of vaginal symptoms—specifically presence, concurrency, and recurrence frequency—and cytological abnormalities, HPV positivity and bacterial vaginosis (p > 0.05). In contrast, the prevalence of moderate-to-severe inflammation was significantly higher in women with vaginal discharge and a greater symptom burden (p < 0.05). Pruritus, dysuria, and vaginal burning were significantly associated with Candida positivity (p < 0.05). However, no significant association was found between the severity of cervical inflammation and abnormal cytology or HPV positivity (p > 0.05). In multivariable logistic regression analyses, neither symptom burden nor cervical inflammation severity was independently associated with abnormal cytology or HPV positivity. Conclusions: Our findings indicate that vaginal symptoms and the severity of cervical inflammation may not serve as definitive or independent discriminatory markers for cellular abnormalities or HPV positivity in this context. Nevertheless, specific symptom patterns may assist clinicians in evaluating localized infectious processes. Consequently, while standard cytological and molecular protocols remain essential for oncogenic screening, evaluating the overall symptom burden provides clinicians with a valuable framework for identifying benign dysbiotic and inflammatory processes. These findings remained consistent after adjustment for major clinical confounders.