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The Utility of Wet Prep in Predicting Neisseria gonorrhoeae and Chlamydia trachomatis

      Abstract

      Background

      Diagnosing Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) cervical infections can be difficult in the Emergency Department without real-time testing, as historical and physical elements are known to be unreliable.

      Objective

      To evaluate the utility of the vaginal wet mount preparation (wet prep) in predicting an infection with NG or CT.

      Methods

      A retrospective chart review was performed on 12 months of data from September 2007 to August 2008 on patients aged 18 years and above who had a chief complaint requiring a pelvic examination and had concurrent testing for NG/CT and a wet prep. Wet preps were analyzed and reported as quantity of white cells and clue cells present (none, few, moderate, or many) as well as the presence of Trichomonas vaginalis (TV). Wet prep results were evaluated to see if there was a correlation with NG/CT.

      Results

      There were 2439 patient encounters reviewed. A total of 373/2439 (15.3%) patient encounters were positive for NG or CT; 272/2439 (11.2%) were positive for TV, whereas 966/2439 (39.6%) had white cells and 995/2439 (40.8%) had clue cells on wet prep. Clue cells and TV did not correlate with the presence of NG or CT. Only the presence of “moderate” and “many” white cells correlated with NG or CT (odds ratio [OR] 1.58, 95% confidence interval [CI] 1.12–2.22 and OR 2.47, 95% CI 1.86–3.27, respectively).

      Conclusion

      In patients who are diagnosed with NG or CT, the presence of TV or clue cells on wet prep is an unreliable marker for diagnosis. However, having moderate or many white cells present on wet prep does increase the probability of concurrent NG or CT infection and may be used in cases where the clinical suspicion is equivocal.

      Keywords

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      References

        • Centers for Disease Control and Prevention (CDC)
        Sexually transmitted diseases surveillance, 2009.
        Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, GA2010
        • Bachman L.H.
        • Pigott D.
        • Desmond R.
        • et al.
        Prevalence and factors associated with gonorrhea and chlamydial infections in at-risk females presenting to an urban emergency department.
        Sex Transm Dis. 2003; 30: 335-339
        • Chesson H.W.
        • Blandford J.M.
        • Gift T.L.
        • Tao G.
        • Irwin K.L.
        The estimated direct medical cost of sexually transmitted diseases among American youth, 2000.
        Perspect Sex Reprod Health. 2004; 36: 11-19
        • Moodley P.
        • Wilkinson D.
        • Connolly C.
        • et al.
        Trichomonas vaginalis is associated with pelvic inflammatory disease in women infected with human immunodeficiency virus.
        Clin Infect Dis. 2002; 34: 519-522
        • Cherpes T.L.
        • Wiesenfeld H.C.
        • Melan M.A.
        • et al.
        The associations between pelvic inflammatory disease, Trichomonas vaginalis infection, and positive herpes simplex virus type 2 serology.
        Sex Transm Dis. 2006; 33: 747-752
        • Centers for Disease Control and Prevention (CDC)
        Sexually transmitted diseases treatment guidelines, 2010.
        MMWR Recomm Rep. 2010; 59: 1-110
        • Yealy D.M.
        • Greene T.J.
        • Hobbs G.D.
        Underrecognition of cervical Neisseria gonorrhoeae and Chlamydia trachomatis infections in the emergency department.
        Acad Emerg Med. 1997; 4: 962-967
        • Kelly J.J.
        • Dalsey W.C.
        • McComb J.
        • Njuki F.
        Follow-up program for emergency department patients with gonorrhea or chlamydia.
        Acad Emerg Med. 2000; 7: 1437-1439
        • Mehta S.D.
        • Rothman R.E.
        • Kelen G.D.
        • Quinn T.C.
        • Zenilman J.M.
        Unsuspected gonorrhea and chlamydia in patients of an urban adult emergency department: a critical population for STD control intervention.
        Sex Transm Dis. 2001; 28: 33-39
        • Hack J.B.
        • Hecht C.
        Emergency physicians’ patterns of treatment for presumed gonorrhea and chlamydia in women: one center’s practice.
        J Emerg Med. 2009; 37: 257-263
        • Reynolds M.
        • Wilson J.
        Is Trichomonas vaginalis still a marker for other sexually transmitted infections in women?.
        Int J STD AIDS. 1996; 7: 131-132
        • Street D.
        • Wells C.
        • Taylor-Robinson D.
        • Ackers J.
        Interaction between Trichomonas vaginalis and other pathogenic micro-organisms of the human genital tract.
        Br J Vener Dis. 1984; 60: 31-38
        • White M.J.
        • Sadalla J.K.
        • Springer S.R.
        • Counselman F.
        Is the presence of Trichomonas vaginalis a reliable predictor of coinfection with Chlamydia trachomatis or Neisseria gonorrhoeae in female ED patients?.
        Am J Emerg Med. 2005; 23: 127-130
        • Wegner S.
        • Yen M.J.
        • Witting M.
        Evidence against the “booty pack”: Trichomonas not associated with gonorrhea or Chlamydia.
        J Emerg Med. 2009; 37: 124-126
        • Geisler W.M.
        • Yu S.
        • Venglarik M.
        • Schwebke J.R.
        Vaginal leucocyte counts in women with bacterial vaginosis: relation to vaginal and cervical infections.
        Sex Transm Infect. 2004; 80: 401-405
        • Wiesenfeld H.C.
        • Hillier S.L.
        • Krohn M.A.
        • Landers D.V.
        • Sweet R.L.
        Bacterial vaginosis is a strong predictor of Neisseria gonorrhoeae and Chlamydia trachomatis infection.
        Clin Infect Dis. 2003; 36: 663-668
        • Peipert J.F.
        • Montagno A.B.
        • Cooper A.S.
        • Sung C.J.
        Bacterial vaginosis as a risk factor for upper genital tract infection.
        Am J Obstet Gynecol. 1997; 177: 1184-1187
        • Amsel R.
        • Totten P.A.
        • Spiegel C.A.
        • Chen K.C.
        • Eschenbach D.
        • Holmes K.K.
        Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations.
        Am J Med. 1983; 74: 14-22
        • Thomason J.L.
        • Gelbart S.M.
        • Anderson R.J.
        • Walt A.K.
        • Osypowski P.J.
        • Broekhuizen F.F.
        Statistical evaluation of diagnostic criteria for bacterial vaginosis.
        Am J Obstet Gynecol. 1990; 162: 155-160
        • Sodhani P.
        • Garg S.
        • Bhalla P.
        • et al.
        Prevalence of bacterial vaginosis in a community setting and role of the pap smear in its detection.
        Acta Cytol. 2005; 49: 634-638
        • Ness R.B.
        • Kip K.E.
        • Soper D.E.
        • et al.
        Bacterial vaginosis (BV) and the risk of incident gonococcal or chlamydial genital infection in a predominantly black population.
        Sex Transm Dis. 2005; 32: 413-417
        • Brotman R.M.
        • Klebanoff M.A.
        • Nansel T.R.
        • et al.
        Bacterial vaginosis assessed by gram stain and diminished colonization resistance to incident gonococcal, chlamydial, and trichomonal genital infection.
        J Infect Dis. 2010; 202: 1907-1915
        • Nugent R.
        • Krohn M.A.
        • Hillier S.
        Reliability of diagnosing bacterial vaginosis is improved by a standard method of gram stain interpretation.
        J Clin Microbiol. 1991; 29: 297-301
        • Steinhandler L.
        • Peipert J.F.
        • Heber W.
        • Montagno A.
        • Cruickshank C.
        Combination of bacterial vaginosis and leukorrhea as a predictor of cervical chlamydial or gonococcal infection.
        Obstet Gynecol. 2002; 99: 603-607
        • Hakakha M.M.
        • Davis J.
        • Korst L.M.
        • Silverman N.S.
        Leukorrhea and bacterial vaginosis as in-office predictors of cervical infection in high-risk women.
        Obstet Gynecol. 2002; 100: 808-812

      Linked Article

      • Sensitivity and Specificity of the Vaginal Wet Prep
        Journal of Emergency MedicineVol. 46Issue 1
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          It is with great interest that we read the study on the utility of vaginal wet preps performed in the emergency department, reported by Lo et al. (1). We also performed a conceptually similar study using endocervical Gram stains but we came to different conclusions (2). Although there were some methodological differences (e.g., Lo et al. used vaginal wet prep and reported white blood cell [WBC] quantities as “none,” “few,” “moderate,” and “many,” whereas we used endocervical Gram stain and reported WBC quantity as > 10 per high-powered field), in both studies the authors assessed the quantity of WBCs as a possible indicator of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infection (1).
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