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The presence of
leukorrhea is strongly associated with cervical infection with C.
trchomatis and N. gonorrhoeae in high-risk women.
Leukorrhea and
bacterial vaginosis as in-office predictors of cervical infection in
high-risk women.
Hakakha MM, Davis J, Korst LM,
Silverman NS.
Obstet Gynecol. 2002;100:808-812.
Summary:
Question
Is the presence of microscopic leukorrhea or bacterial vaginosis
associated with cervical infection with C. trachomatis or N.
gonorrhoeae in high-risk women, and does pregnancy affect the
association?
Design
The presence of leukorrhea and bacterial vaginosis in vaginal secretions
was compared to the detection of C. trachomatis and N.
gonorrhoeae by culture in pregnant and nonpregnant women at high risk
for cervical infections.
Participants
One hundred ninety-four consecutive new obstetric and gynecologic patients
undergoing routine pelvic examination at two resident-staffed clinics in
Los Angeles, CA that serve a high-risk, transient population of primarily
adolescent/young-adult inner-city women were tested. One hundred eighteen
(60.8%) women were pregnant.
Description of Tests and Diagnostic
Standard
Swabs used to obtain vaginal secretions or discharge were placed into both
normal saline and potassium hydroxide solutions for microscopic
examination at 400X using a light microscope. Leukorrhea was defined as
>10 white blood cells per high-power field. Amsel criteria were used to
determine the presence of bacterial vaginosis. Cervical cultures for N.
gonorrhoeae and C. trachomatis were performed.
Main Outcome Measures
The association of leukorrhea and bacterial vaginosis with a positive
culture result for either C. trachomatis or N. gonorrhoeae
was determined by multivariate analysis.
Main Results
The overall rate of cervical infection was 21/194 (10.8%). One woman was
infected with N. gonorrhoeae alone, and four women were co-infected
with both. There were no differences in clinical signs studied between
pregnant and nonpregnant women. With the exception of one case, bacterial
vaginosis as defined either by clue cells alone or by Amsel criteria was
noted only in the presence of leukorrhea. Among nonpregnant women, those
who had leukorrhea were 58.7 times more likely to have a positive culture
result than women without leukorrhea [11/12 (91.7%) versus 1/64 (1.6%),
P< .001, RR=58.7 (95% confidence interval 8.3, 413.2)]. Among pregnant
women, leukorrhea was still associated with an increased risk of a
positive cervical culture, although the relative risk could not be
calculated [9/15 (60%) versus 0/103 (0%), P<.001]. The performance of
leukorrhea for prediciting cervical infection among pregnant and
nonpregnant women as determined by N. gonorrhoeae and C.
trachomatis cultures is shown in the table.
| Performance
of leukorrhea for diagnosis of cervical infection in high risk women |
| Patient
characteristic |
Performance
parameter (%) |
| Sensitivity |
Specificity |
PPV |
NPV |
| Pregnant |
100 |
95 |
60 |
100 |
| Nonpregnant |
92 |
98 |
92 |
98 |
Authors' Conclusions
The presence of leukorrhea on microscopic
examination in an outpatient setting was strongly associated with
concomitant cervical infection with C. trachomatis or N.
gonorrhoeae among both pregnant and nonpregnant women. In-office wet
mounts ma0y serve as sensitive, rapid screening tests that could help
eliminate the problems associated with non-compliance and poor follow-up
in high-risk, transient populations.
Source of funding: None given.
For correspondence: Neil S. Silverman,
Cedars-Sinai Medical Center, Department of Obstetrics and Gynecology, 8635
W. 3rd Street, Suite 160 West, Los Angeles, CA 90048. E-mail address:
silvermann@cshs.org.
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