Pilot study to evaluate the appropriate management of patients with coexistent bacterial vaginosis and cervicitis.

A pilot study was performed to obtain preliminary data regarding the need for targeted therapy of bacterial vaginosis (BV) when it accompanies clinically defined cervicitis. Specifically, women attending a sexually transmitted disease (STD) clinic with clinically defined BV and cervicitis were treated in the first phase of the study with doxycycline alone. In phase II, the patients received doxycycline and concomitant intravaginal metronidazole gel. All patients were reexamined 3-4 weeks after therapy. Persistence of BV occurred in 18/19 (95%) of women in phase I vs. 1/7 (14%) of women in phase II (P < 0.001). We concluded that, in women with coexistent clinically defined cervicitis and BV, the treatment of cervicitis does not result in a normalization of the vaginal flora.

Effectiveness of Gonozyme for detection of gonorrhea in low-risk pregnant and gynecologic populations.

The Gonozyme Diagnostic Kit (Abbott Laboratories, North Chicago, IL) was evaluated in a population at low-risk for gonorrhea. Two hundred seventy-two female patients, consisting of 152 obstetrical patients and 120 gynecologic patients attending a family-planning clinic, were tested for Neisseria gonorrhoeae by use of culture and Gonozyme testing of specimens from the endocervical canal. The average ages were 16.1 years for the obstetric patients and 17.8 years for the gynecologic patients. The overall sensitivity of Gonozyme as compared with culture was 60.8% (57.1% for obstetric patients and 62.5% for gynecologic patients); the overall specificity was 98.4%. An association was observed between the number of colony-forming-units (cfu) per plate and a positive Gonozyme test; specimens with less than 60 cfu/plate usually yielded a negative Gonozyme result. We conclude that Gonozyme is a highly specific test but its low sensitivity as compared with that of culture does not allow it to replace standard culture media for screening of low-risk women for infection with N. gonorrhoeae.

Comparison of four methods to detect Trichomonas vaginalis.

Four methods for the detection of Trichomonas vaginalis in vaginal secretions from 88 symptomatic patients were compared: wet-mount examination, Kupferberg liquid medium, Hirsch charcoal agar, and the Papanicolaou smear. Hirsch diphasic slants and Kupferberg medium did not significantly differ in sensitivity from direct examination of wet mounts. The Papanicolaou smear identification of trichomonads was found to be the least sensitive method evaluated.

Preliminary experience with a family planning risk-scoring system.

PIP: Utilizing a risk scoring system for selection of the proper contraceptive method for women seeking family planning care is discussed and recommended as being attractive and practical. Because there are risks associated with specific contraceptive methods, such as thrombosis with oral contraception and pelvic infections with intrauterine contraception, it is necessary to preselect the safest method for individual women. Testing 495 women upon their first visit to the clinic, the authors compared each woman's desired method with the methods selected for by the risk-scoring system. Based on a point score of 1-10 with 10 indicating high risk, it is shown that 42% of the women desiring oral contraception had some risk to be considered while 5.1% had a high risk score. For women desiring the intrauterine device, 28.6% had some risk factor while 4.2% had a high risk score. They conclude that 3 advantages are: 1) the system was easy to use and pointed out problem areas before a method was selected, 2) the system provided a means of quickly monitoring the patient's care by a large number of persons, and 3) the scoring sheet served as a teaching device.^ieng