Papanicolaou (Pap) smears taken at the first antenatal visit of black African women were examined for lactobacillary expression and its correlation with the prevalence of genital infections and with the outcome of pregnancy. Lactobacillary morphotypes were absent (grade III) in 52% of 256 women. Trichomonas, Chlamydia, gonococci, or syphilis was identified in 54% of grade III women, and in 17% of grade I + II women (p < 0.0001). There were partially independent positive associations of Trichomonas, Chlamydia, and gonococci and a negative association of Candida morphotypes with grade III. Absence of lactobacilli, whether or not in the context of bacterial vaginosis, is an indicator for the presence of other genital infections. Birthweight was 2000 gm or less in 5% of 82 children of grade I + II mothers, and in 16% of 83 children of grade III mothers (p = 0.02). Thus, there are populations in whom the grading of lactobacilli in routine Pap smears helps to direct further investigations and to predict the outcome of pregnancy.