it is estimated that there were 1,12,609 cases of cervical cancer in the year 2004 and the number will rise to 1,39,864 in the year 2015 . this country has the largest burden of cervical cancer patients in the world and one of every five cervical cancer patients belongs to this country . however , diagnosed in the early stages and treated early , cervical cancer is a curable disease . there are several methods for cervical cancer screening and several studies have established the importance of papanicolaou ( pap ) smear as one of the easy and important screening methods for cervical cancer . routine cervical screening by pap smear resulted in decreasing the incidence of cervical cancer in many countries of the developed world . however in india , in spite of national recommendation , routine cervical screening program is not done and as a result , the prevalence of different epithelial lesions of the cervix is not known . our study was initiated to detect the prevalence and spectrum of cervical epithelial abnormalities among female sex workers ( fsws ) by pap smear . this study group was selected because many other studies done previously showed high rates of epithelial lesions among this population due to different risk factors . this was a prospective study carried out during a period of 1 year ( from august 2011 to july 2012 ) . all the fsws attending outpatient department during this time period with different clinical symptoms such as abdominal pain , bleeding per vagina , vaginal discharge , irregular menstruation etc . samples were taken by brushes / ayre spatula , immediately fixed in alcohol and stained using pap technique by trained technicians . reporting was done by two consultant cytopathologists according to the bethesda system ( tbs ) . slides were reported as normal smear , inflammatory smear , specific infection , atypical squamous cell of undetermined significance ( ascus ) , low grade squamous intraepithelial lesion ( lsil ) , high grade squamous intraepithelial lesion ( hsil ) , squamous cell carcinoma ( scc ) and atypical glandular cell of undetermined significance ( agus ) . a total of 60 cases were included in this study during the time period of 1 year . total 16 ( 26.67% ) out of 60 patients were below the age of 30 years and 44 ( 73.33% ) were above 30 years of age . out of 60 smears , 52 ( 86.67% ) smears showed pathologic findings [ figures 1 and 2 ] . premalignant lesions were found in 37 ( 61.67% , n = 60 ) smears of which ascus was 2 ( 3.3% ) , lsil-9 ( 15% ) , hsil-23 ( 38.3% ) , scc-2 ( 3.3% ) and agus-1 ( 1.7% ) [ table 1 ] . among the patients of below 30 years ( n = 16 ) , premalignant lesions were found in 8 ( 50% ) patients of which ascus was 1 ( 6.3% ) , lsil-5 ( 31.2% ) and hsil-2 ( 12.5% ) [ table 1 ] . total inflammatory smears were 36 ( 60% , n = 60 ) , of which 12 smears showed nonspecific inflammation , 10 smears were associated with hsil , 8 smears were associated with lsil , 2 smears were associated with ascus , 1 smear was associated with agus and 3 smears were associated with specific infections . one smear showed features of both human papilloma virus ( hpv ) and herpes simplex virus ( hsv ) infections , 2 smears were associated with features of both hpv and trichomonas vaginalis infections . ( b ) photomicrograph showing low grade squamous intraepithelial lesion with koilocytic change in some of the cells ( pap , 400 ) . the cells have mild increase in nucleocytoplasmic ratio and hyperchromatic nuclei ( a ) photomicrograph showing high grade squamous intraepithelial lesion having moderate increase in the nucleocytoplasmic ratio , anisonucleosis and hyperchromatic nuclei with irregular nuclear membrane ( pap , 400 ) . ( b ) photomicrograph showing squamous cell carcinoma having overlapping of the nuclei , severe increase in the nucleocytoplasmic ratio , hyperchromatic nuclei with conspicuous nucleoli ( pap , 400 ) spectrum of abnormalities in cervical pap smears among female sex workers cervical cancer has a long latent phase with identifiable and treatable premalignant lesions which precede the invasive disease , and the benefit of conducting screening exceeds the cost involved . firstly , the incidence of ascus and lsil was almost same for the below 30 and above 30 years age group , but the incidence of hsil and scc was greatly increased in the above 30 years age group indicating the gradually increasing incidence of malignancy with age . these results are in accordance with the studies of bal et al . , and elhakeem et al . secondly , in the age group of below 30 years , 9 out of 16 ( 56.25% ) patients were candidates for follow - up ( due to the presence of hsv infection , ascus , lsil / hsil ) , emphasizing the need for screening even in the below 30 years age group . thirdly , 24 out of 36 ( 66.67% ) inflammatory smears were associated with epithelial lesions , indicating the importance of proper hygiene maintenance in prevention of cervical epithelial lesions . we compared the results obtained in this study with some studies made on the general population . in comparison to these studies , a very high incidence of epithelial lesions was found in this study [ table 2 ] . the probable causes for the discrepancy observed , include the fact that our study population ( fsws ) are exposed to all the risk factors for cervical epithelial lesions in contrast to the general population . comparison of results with other studies carried out among general population we also compared the results obtained in this study with few studies done on sex workers . in comparison , our study showed a higher incidence of epithelial lesions , particularly hsil [ table 3 ] . the main reason for this discrepancy is because this study includes only the symptomatic patients who came to the out patient 's department for medical advice . other possible causes for the discrepancy may be a small denominator population in this study , and a poorer standard of living and lack of awareness in our study population in contrast to that of other developed countries . comparison of results with other studies carried out among sex workers there were a few limitations in our study . first of all , we could not include a control population in our study and secondly , we could not find the true incidence because the asymptomatic cases could not be included in the study population . despite the small study population , several important deductions can be made from this study . firstly , considering the higher incidence of epithelial lesions in the below 30 years age group , it is recommended that the age of routine cervical cancer screening should be much earlier than the national recommendation . secondly , as the incidence of epithelial lesions is quite high in our study population ( 61.67% ) , close follow - up of this target population ( i.e. , fsws ) and histological examination , is necessary to avoid unnecessary spread of neoplastic disease and untimely death of the patients . furthermore , awareness about the disease and diagnostic utility of pap test , among fsws is also a must .
background : papanicolaou ( pap ) test is an important and easy diagnostic tool to detect any abnormalities on vaginal cytology . 
 pap test is routinely done in women of reproductive age group in many countries.aim:the aim of this study was to detect spectrum of abnormalities in female sex workers ( fsws ) on vaginal cytology.materials and methods : a total of 60 cases were included over a period of 1 year ( july , 2011-june , 2012 ) . 
 the age range of the patients was 14 - 61 years . 
 pap stained slides were evaluated by two consultant cytopathologists and reported as normal smear , inflammatory smear , specific infection , low grade squamous intraepithelial lesion ( lsil ) , high grade squamous intraepithelial lesion ( hsil ) , atypical squamous cell of undetermined significance ( ascus ) , squamous cell carcinoma ( scc ) and atypical glandular cell of undetermined significance ( agus).results : most of the smears were abnormal accounting for 86.7% of total cases ( 52/60 ) . 
 incidence of hsil was very high in fsws . 
 out of 60 cases , 8 normal smears ( 13.3% ) , 12 inflammatory smears ( 20% ) , 3 cases of infections ( 5% ) , 9 cases of lsil ( 15% ) , 23 cases of hsil ( 38.3% ) , 2 cases ( 3.3% ) each of ascus and scc and 1 case ( 1.3% ) agus were encountered.conclusions:close follow - up and histologic examinations are necessary to avoid unnecessary spread of the neoplastic disease and untimely death of the patients . 
 awareness about diseases in fsws and diagnostic utility of pap test are also a must .