Elsevier

Obstetrics & Gynecology

Volume 100, Issue 3, September 2002, Pages 579-584
Obstetrics & Gynecology

Original research
Predicting chlamydial and gonococcal cervical infection: implications for management of cervicitis

Presented in part at the STIs at the Millenium Conference, May 2000, Baltimore, Maryland.
https://doi.org/10.1016/S0029-7844(02)02140-3Get rights and content

Abstract

OBJECTIVE:

To define utility of age and cervical findings in predicting infection with Chlamydia trachomatis and Neisseria gonorrhoeae among women universally tested for both infections, and to assess the independent contribution of Gram stain (GS) smear of endocervical secretions.

METHODS:

Visits by women to Seattle sexually transmitted diseases clinics from 1995 through 1999 were retrospectively reviewed. All women had endocervical GS and cultures for C trachomatis and N gonorrhoeae performed. Predictive values of age, cervical signs, and inflammation on GS (more than 30 polymorphonuclear leukocytes per 1000× field) were calculated.

RESULTS:

Among 6230 women, prevalence of C trachomatis and N gonorrhoeae was 6.9% and 2.1%, respectively; 520 women (8.3%) had either organism detected. Age, cervical signs (mucopus, induced bleeding), and inflammation on endocervical GS were independently associated with infection. However, the positive predictive value (PPV) of any cervical finding for infection was less than 19% in women 25 years and older. Inflammation on endocervical GS was the sole indicator of infection in 79 of 520 (15%) infections, but was insensitive in the absence of mucopurulent cervicitis (sensitivity, 26%; PPV, 21%).

CONCLUSION:

Cervical signs suggesting chlamydial or gonococcal infection have higher positive predictive value (PPV) in younger women. The PPV of inflammation on endocervical GS is too low to recommend its use to direct empiric treatment in the absence of mucopurulent cervicitis, especially in women 25 years and older. Further, its low sensitivity in detecting infection in women without mucopurulent cervicitis does not justify routine use. Signs suggesting mucopurulent cervicitis should be interpreted in the context of age, and empiric treatment may not be indicated in women aged 25 years and older.

Section snippets

Materials and methods

Electronic client records for new problem visits from 1995 through 1999 to the Public Health, Seattle and King County STD Clinic at Harborview Medical Center in Seattle were analyzed. The analysis of the data presented in this article was approved by the University of Washington Human Subjects Review Committee. Follow-up visits were excluded, as were those from women who did not undergo pelvic examination. Demographic data were collected at clinic registration; other information (patient

Results

Records for 11,014 visits by women to the clinic during the study period were reviewed. Of these, 6230 new problem visits by women who underwent pelvic examination, did not have signs of pelvic inflammatory disease, and were tested for C trachomatis and N gonorrhoeae were included in the analysis. Subjects’ age distribution, race, sexual history, and cervical findings are displayed in Table 1. Of these 6230 women, 430 (6.9%) had C trachomatis and 133 (2.1%) had N gonorrhoeae detected by

Discussion

Our analysis of a large number of women universally tested for endocervical infection with C trachomatis and N gonorrhoeae by culture yielded several clinically important findings. First, the data indicate that signs of cervicitis should be interpreted in the context of age. Cervical signs suggesting chlamydial or gonococcal infection had higher PPV in younger women. Approximately one in three women less than 25 years old with any cervical finding had infection with one or both of these

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    This study was supported in part by National Institutes of Health grant R29-AI41153-04 (JMM).

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