General Obstetrics and Gynecology Gynecology
Vaginal polymorphonuclear leukocytes and bacterial vaginosis as markers for histologic endometritis among women without symptoms of pelvic inflammatory disease,☆☆

https://doi.org/10.1067/mob.2003.105Get rights and content

Abstract

Objective: The study was performed to determine whether vaginal polymorphonuclear leukocytes can be used as predictors of histologic endometritis among women at risk for, but without symptoms of, acute pelvic inflammatory disease. Study design: Five hundred thirty-seven women with, or at risk for, pelvic infection underwent pelvic examinations, including endometrial biopsies. These women were assessed for the presence of vaginal polymorphonuclear leukocytes, bacterial vaginosis, sexually transmitted diseases, and histologic endometritis. Results: Vaginal neutrophils were present in 240 (44.7%) and histologic endometritis was present in 77 (14.3%) of the study population. Women with histologic endometritis were significantly more likely to have vaginal neutrophils present, with an odds ratio of 3.2 (95% CI 1.9-5.7). When study subjects were stratified by the presence of sexually transmitted diseases and vaginal neutrophils, the prevalence of histologic endometritis was highest in women with both conditions present, with an odds ratio of 7.0 (95% CI 3.5-14.3). When subjects were stratified by the presence of bacterial vaginosis and vaginal neutrophils, the prevalence of histologic endometritis was again highest in women with both conditions present, with an odds ratio of 4.8 (95% CI 1.4-16.3). The presence of vaginal neutrophils diagnosed by saline wet mount had a high sensitivity (90.9%) and negative predictive value (94.5%), but a low specificity (26.3%) and positive predictive value (17.1%) for the diagnosis of upper genital tract infection. Conclusion: The presence of vaginal polymorphonuclear leukocytes has a high sensitivity and negative predictive value for the diagnosis of upper genital tract infection. (Am J Obstet Gynecol 2003;188:318-23.)

Section snippets

Study population

Before recruitment, this study was approved by the Magee-Womens Hospital institutional review board. Women were recruited from 4 clinical sites in Pittsburgh, Pa. These included an urban sexually transmitted diseases clinic, 2 ambulatory gynecology clinics, and 2 community-based primary care clinics. Recruitment took place from May 1998 to September 2001. Women aged 15 to 30 were eligible for enrollment if they had one of the following: Cervicitis caused by N gonorrhoeae or C trachomatis ;

Results

Among the 537 women entered in this study during the enrollment period, vaginal neutrophils (≥1 per oil field) were present in 240 (44.7%) and histologic endometritis was present in 77 (14.3%). The prevalence of infection with N gonorrhoeae and C trachomatis in the study population was 11.1% and 21.5%, respectively. Characteristics of women with and without the presence of vaginal neutrophils are summarized in Table I.

. Characteristics of women, stratified by presence or absence of vaginal

Comment

In this study of 537 women with or at risk for pelvic infection, 240 (44.7%) had vaginal neutrophils and 77 (14.3%) had histologic endometritis. Women with endometritis were significantly more likely to have vaginal neutrophils present, with an odds ratio of 3.2. This association between vaginal neutrophils and histologic endometritis persisted even after controlling for bacterial vaginosis. Interestingly, when we stratified women by the presence or absence of both vaginal neutrophils and

Acknowledgements

We thank the Allegheny County Health Department Sexually Transmitted Diseases Clinic and the Family Health Council Clinics of Aliquippa and East Liberty.

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Supported by National Institutes of Health grant No. R01 AI41624-01.

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