In a prospective study of 124 urban black pregnant women, 43% had Candida isolated from endocervical cultures and 20% had Candida cell forms on cytological Pap-stained cervical specimens. The presence of Candida cell forms on Pap smears had a better correlation with Candida colonisation when normal lactobacillary flora was present, when Trichomonas vaginalis parasites were absent and when the infecting Candida species was C. albicans. Positive cultures were strongly related to a number of clinical signs and symptoms, but Pap smears were not. Neither Candida culture nor Candida cells in Pap smear revealed an association with premature delivery, birth weight, severe neonatal morbidity or mortality. We confirm that the routine cervical Pap smear is not a sensitive method for diagnosing symptomatic fungal infection. More specifically, some of the Pap smear characteristics, such as disturbed lactobacillary flora or co-infection with T. vaginalis, interfere with accurate diagnosis.