Disease prevalence among women attending a sexually transmitted disease clinic varies with reason for visit.

Prevalence of sexually transmitted diseases (STD) and selected behavioral and demographic variables were evaluated in 279 women attending a Baltimore STD clinic, using a standardized questionnaire and cultures for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis. Stratified by reason for clinic visit, 102 (37%) of 279 women attending the clinic stated that they were recent contacts to men with STDs with the majority (59 out of 102, or 58%) reporting gonorrhea contact as their reason for visit. Another 124 women (44%) came to the clinic for symptom evaluation, and 53 (19%) for other reasons. Prevalence of STDs was higher among those attending as contacts than among noncontacts: 35% versus 15% for N. gonorrhoeae; 26% versus 16% for C. trachomatis; and 27% versus 15% for T. vaginalis (P less than 0.05 for each). Furthermore, multiple infections were found in 23% of those attending as contacts but only in 10% of noncontacts (P less than 0.001). In general, patients reporting contact with an infected person were also less likely to report symptoms (43% versus 34%, P less than 0.001), despite increased disease prevalence. These data suggest that multiple STDs are often present in women attending STD clinics, irrespective of reason for visit. Merely treating women for reported exposure without further evaluation will fail to identify a substantial number of women coinfected with other organisms.

Surrogate methods to diagnose gonococcal and chlamydial cervicitis: comparison of leukocyte esterase dipstick, endocervical gram stain, and culture.

This study compared leukocyte esterase dipsticks (LED) and endocervical Gram stains (EGS) as surrogates for culture diagnosis of gonococcal and chlamydial cervicitis in 495 STD clinic patients. Overall, gonorrhea prevalence was 15.7%; chlamydia prevalence (in the subgroup that was tested) was 17.8%. In diagnosing gonorrhea, LED and EGS performed similarly, with sensitivities of 68% and 76%, respectively, and identical specificities of 44%. In diagnosing gonococcal or chlamydial cervicitis, LED and EGS sensitivities fell to 48% and 47%, respectively, whereas specificities increased to 55% and 75%. These data suggest that, although both tests are imperfect surrogates for gonococcal and chlamydial culture, LED sacrifices little in sensitivity compared with EGS. Because LED does not require ancillary supplies, equipment, electricity, or trained personnel, its use may be feasible when Gram-stain diagnosis is impossible. Modifications of LED technology and specimen preparation should be sought to improve LED performance.