Elsevier

Obstetrics & Gynecology

Volume 100, Issue 4, October 2002, Pages 808-812
Obstetrics & Gynecology

Original research
Leukorrhea and bacterial vaginosis as in-office predictors of cervical infection in high-risk women

https://doi.org/10.1016/S0029-7844(02)02147-6Get rights and content

Abstract

OBJECTIVE:

To evaluate 1) whether microscopic detection of leukorrhea or bacterial vaginosis identifies patients at high risk for cervical infection with Chlamydia trachomatis or Neisseria gonorrhoeae, and 2) if pregnancy alters the predictive value of these findings.

METHODS:

Wet-mount screening examination of vaginal discharge was performed on all new patients seen at two resident-staffed clinics serving primarily indigent women. Leukorrhea was defined as >10 white blood cells per high-power field on microscopic examination; Amsel criteria were used to determine the presence of bacterial vaginosis, with a positive clue cell test result defined as >20% of epithelial cells. The diagnoses of C trachomatis and N gonorrhoeae infection were established by deoxyribonucleic acid amplification tests.

RESULTS:

The study population consisted of 194 women, 118 (61%) of whom were pregnant. Overall, 11% of women had positive cultures for chlamydia or gonorrhea. Although both leukorrhea and clue cells were independently associated with positive cervical cultures, multivariate analysis found that clue cells did not contribute to the predictive value of leukorrhea alone among both pregnant (relative risk [RR] = 15.7) and nonpregnant (RR = 58.7) women. Negative predictive values for the screening test were comparably high (98–100%), independent of pregnancy status.

CONCLUSION:

Leukorrhea, in the presence or absence of bacterial vaginosis, was strongly associated with cervical infections with C trachomatis or N gonorrhoeae among both pregnant and nonpregnant patients. In settings where patient follow-up is uncertain, on-site screening tests identify women for whom empiric antibiotic therapy for sexually transmitted diseases may be appropriate.

Section snippets

Materials and methods

The study population consisted of consecutive new obstetric and gynecologic patients seen in two resident-staffed, inner-city clinics in Los Angeles between August 2000 and April 2001. All patients invited to participate consented to inclusion in this study. Two clinic sites were utilized: 1) the Los Angeles Free Obstetric Clinic in Hollywood, and 2) the Cedars-Sinai Medical Center outpatient Obstetrics and Gynecology Clinic in West Los Angeles. The study protocol was approved by the Medical

Results

Of the 194 women evaluated for the study, 118 (60.8%) were pregnant. An overview of patient characteristics identified for the entire study population and stratified by pregnancy status is shown in Table 1. The overall rate of cervical infection, the primary outcome measure for this study, was 11% (10/194); only one woman was infected with gonorrhea alone, and four women (2%) were co-infected with both chlamydia and gonorrhea. Table 1 demonstrates that, except for patient age, there were no

Discussion

We have demonstrated that the presence of leukorrhea, in the presence or absence of bacterial vaginosis on microscopic examination in an outpatient setting, is strongly associated with concomitant cervical infection with C trachomatisor N gonorrhoeae. Multivariate analysis revealed that the presence of leukorrhea in particular was a very strong predictor of cervical infection, particularly with chlamydia, in both nonpregnant (RR = 58.7) and pregnant (RR = 15.7) patients, after considering age,

References (15)

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