Introduction: Cannonballs are structures consisting of neutrophils adherent to epithelial cells, often seen in vaginal Pap smears of patients with trichomoniasis and chlamydiasis. We frequently observed these cannonballs in inflammatory Pap smears showing evidence of bacterial vaginosis. Objective: To study the association between cannonballs and bacterial vaginosis with associated infections in inflammatory Pap smears. Study Design: This was a retrospective study performed over a period of 6 months between April 2014 and September 2014. Three hundred consecutive Pap smears assessed during the study period were retrieved from the archives and studied. Results: A total of 280 smears were studied. Neutrophilic infiltrates were seen in 83.6%, cannonballs in 82.3%, and bacterial vaginosis in 70.7% of the smears. Cannonballs were found in 84.4% of the smears showing evidence of bacterial vaginosis with associated inflammatory infiltrates. There was a significant association between cannonballs and bacterial vaginosis (p = 0.0001). The odds ratio was 13.8 (95% CI: 7.2-26.2). Conclusion: The present study shows a significant association between cannonballs and bacterial vaginosis and associated vaginal infections.

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