Leucorreas: valores predictivos de la citología cervicovaginal y del cultivo microbiológico para el diagnóstico de la infección vaginal / Leukorrhea: Predictive values of cervicovaginal cytology and microbiological culture for the diagnosis of vaginal infection

Objetivo y método Estudiamos 122 casos de leucorreas en un año, 52 leucorreas líquidas (42,62%) y 70 leucorreas cremosas (57,37%). Sobre un total de 4.836 consultas representan el 2,52%. Practicamos citología vaginal y cultivo bacteriológico. Calculamos los valores predictivos sobre ambas pruebas. Resultados La citología fue positiva en el 35%. La infección más frecuente fue la vaginosis bacteriana en el 17%. El cultivo fue negativo en el 88%. En los cultivos positivos, las infecciones más frecuentes fueron por Gardnerella vaginalis en el 37%, Candida albicans en el 31% y Candida spp. en el 30%. Cuando hubo correlación positiva de infección en citología y cultivo hubo diferencias significativas (p < 0,05) en leucorreas cremosas. La concordancia de Candidas en citología y Candida albicans y Candida spp. en el cultivo fue significativa (p < 0,01) en leucorreas cremosas. Hubo diferencias significativas (p < 0,01) en el diagnóstico citológico de lesión cervical. Hubo más lesión cervical en las leucorreas líquidas. Los valores predictivos de la citología fueron: sensibilidad = 48%, especificidad = 66%, valor predictivo positivo = 34% y valor predictivo negativo = 77%. Los valores predictivos del cultivo fueron: sensibilidad = 75%, especificidad = 51%, valor predictivo positivo = 36% y valor predictivo negativo = 85%. Conclusiones En el cultivo la sensibilidad fue mayor, detectó más infección. La especificidad fue mayor en la citología, descartó la enfermedad cuando no la había. El valor predictivo positivo fue semejante en ambas pruebas. El valor predictivo negativo fue mayor en el cultivo. Con prueba negativa existió una mayor probabilidad de no padecer la enfermedad(AU)

Objective and method: We studied 122 cases of leukorrhea over a 1-year period: 52 liquidleukorrheas (42.62%) and 70 creamy leukorrheas (57.77%). Of a total of 4836 consultations, leukorrheas represented 2.52%. We performed vaginal cytology and microbiologic culture. We calculated the predictive values of both tests. Results: Cytology was positive in 35%. The most frequent infection was bacterial vaginosis in17%. Culture was negative in 88%. In positive cultures, the most frequent infections were: Gardnerellavaginalis in 37%, Candida albicans in 31% and Candida species in 30%. When there was a positive correlation of infection in cytology and culture, there were significant differences(P < .05) in creamy leukorrheas. The concordance of Candida in cytology and Candida albicans and Candida species in culture was significant (P < .01) in creamy leukorrheas. There were significant differences (P < .01) in the cytologic diagnosis of cervical lesions. There were more cervical lesions in liquid leukorrheas. The predictive values of cytology were as follows: sensitivity = 48%,specificity = 66%, positive predictive value = 34%, and negative predictive value = 77%. The predictive values of culture were sensitivity = 75%, specificity = 51%, positive predictive value = 36%,and negative predictive value = 85%.Conclusions: Sensitivity was higher in culture, which detected more infections. Specificity was higher in cytology, which excluded the disease when not present. The positive predictive value of both tests was similar. The negative predictive value was higher for culture. With negative tests, there was a higher probability that the patient did not have the disease (AU)

Correlation of leukorrhea and Trichomonas vaginalis infection.

Trichomonas vaginalis is a common sexually transmitted infection (STI) causing vaginitis. Microscopy has poor sensitivity but is used for diagnosis of trichomoniasis in resource-poor settings. We aimed to provide a more reliable diagnosis of trichomoniasis by investigating an association with leukorrhea. Women presenting for evaluation of vaginal discharge, STI exposure, or preventative gynecologic examination were evaluated for Trichomonas infection. Vaginal pH was determined and microscopy was performed by the provider, who recorded the number of polymorphonuclear leukocytes (PMNLs) per epithelial cell and the presence of clue cells, yeast, and/or motile trichomonads. Leukorrhea was defined as greater than one PMNL per epithelial cell. Culture and a nucleic acid amplification test (NAAT) were used to detect T. vaginalis. Patients were evaluated for Chlamydia trachomatis and Neisseria gonorrhoeae using NAATs and bacterial vaginosis using Gram stains. Two hundred ninety-four women were enrolled, and 16% were found to have Trichomonas (46/294). Trichomonas infection was more common in parous non-Hispanic, black women, who reported low rates of contraceptive use (33% versus 17%; P = 0.02) and a STI history (85% versus 55%; P = 0.002). These women were more likely to report vaginal discharge (76% versus 59%; P = 0.02) and have an elevated vaginal pH (87% versus 48%; P < 0.001) and gonorrhea infection (15% versus 4%; P = 0.002). Leukorrhea was associated with a 4-fold-increased risk of Trichomonas infection. Leukorrhea on microscopy was associated with Trichomonas vaginitis. Patients with leukorrhea should be evaluated with more-sensitive tests for T. vaginalis, preferably NAATs, if microscopy is negative.

Semiología y exploración ginecológica en la infancia y adolescencia / No disponible

No disponible

A study of leucorrhoea in reproductive age group women of Nagpur City.

A community based cross-sectional study was conducted in reproductive age group women in an urban community of Nagpur, to assess the prevalence of leucorrhoea and the factors influencing the same in these women. The study participants included 506 females, out of which 149 were unmarried and 357 were married. Detailed history and clinical examination was done in all the females including gynecological examination in all the married females. Leucorrhoea was present in 139 (27.47%) females. Leucorrhoea was found significantly more in married females as compared to unmarried (p < 0.001), pregnant as compared to non-pregnant (OR = 2.10, 95% C.I. = 1.02-4.32), and women of lower socioeconomic status (p < 0.001), women with high parity (p < 0.001). Use of Cu-T was not associated with Leucorrhoea (p > 0.05).

Leukorrhea and bacterial vaginosis as in-office predictors of cervical infection in high-risk women.

OBJECTIVE: To evaluate 1) whether microscopic detection of leukorrhea or bacterial vaginosis identifies patients at high risk for cervical infection with Chlamydia trachomatis or Neisseria gonorrhoeae, and 2) if pregnancy alters the predictive value of these findings. METHODS: Wet-mount screening examination of vaginal discharge was performed on all new patients seen at two resident-staffed clinics serving primarily indigent women. Leukorrhea was defined as >10 white blood cells per high-power field on microscopic examination; Amsel criteria were used to determine the presence of bacterial vaginosis, with a positive clue cell test result defined as >20% of epithelial cells. The diagnoses of C trachomatis and N gonorrhoeae infection were established by deoxyribonucleic acid amplification tests. RESULTS: The study population consisted of 194 women, 118 (61%) of whom were pregnant. Overall, 11% of women had positive cultures for chlamydia or gonorrhea. Although both leukorrhea and clue cells were independently associated with positive cervical cultures, multivariate analysis found that clue cells did not contribute to the predictive value of leukorrhea alone among both pregnant (relative risk [RR] = 15.7) and nonpregnant (RR = 58.7) women. Negative predictive values for the screening test were comparably high (98-100%), independent of pregnancy status. CONCLUSION: Leukorrhea, in the presence or absence of bacterial vaginosis, was strongly associated with cervical infections with C trachomatis or N gonorrhoeae among both pregnant and nonpregnant patients. In settings where patient follow-up is uncertain, on-site screening tests identify women for whom empiric antibiotic therapy for sexually transmitted diseases may be appropriate.

Combination of bacterial vaginosis and leukorrhea as a predictor of cervical chlamydial or gonococcal infection.

OBJECTIVE: To evaluate whether the combination of bacterial vaginosis and leukorrhea on microscopic evaluation of a saline wet preparation is associated with cervical infection with Chlamydia trachomatis (C. trachomatis) or Neisseria gonorrhea (N. gonorrhea). METHODS: A cross-sectional study of 598 patients was performed. Nonpregnant patients undergoing a saline wet preparation and microbiologic testing for C. trachomatis and N. gonorrhea were eligible. Providers prospectively collected data from saline microscopic analysis. Bacterial vaginosis was documented based on Amsel's criteria, and ligase chain reaction testing of the endocervix was performed for C. trachomatis and N. gonorrhea. RESULTS: On univariate analysis, young age (less than 25 years), unmarried marital status, black race, and the presence of leukorrhea were all associated with increased rates of testing positive for C. trachomatis and N. gonorrhea (P <.05). We stratified patients into three groups: 1) no evidence of bacterial vaginosis or leukorrhea; 2) evidence of either bacterial vaginosis or leukorrhea, but not both; and 3) evidence of both bacterial vaginosis and leukorrhea. Using logistic regression analysis to control for age, marital status, and race, we found an odds ratio of 3.8 (95% confidence interval 1.3, 11.6) for a positive microbiologic test for either C. trachomatis or N. gonorrhea in women with the combination of bacterial vaginosis and leukorrhea. CONCLUSION: In this group of high-risk women seen in an urgent care facility, the presence of both bacterial vaginosis and leukorrhea was associated with an increased risk of cervical infection. Future prospective studies should evaluate whether empiric treatment of high-risk women with these findings is justified and cost-effective.

[Sexual transmissible diseases and "returning leukorrhea"]. / Maladies sexuellement transmissibles et les "leucorrhées de la rentrée".

White discharges and sexual transmissive diseases are now increasing. Confronted to this symptom, the general practician can easily diagnose and treat his patient. Therefore he must keep in his mind that behind this common symptom, a much more serious disease can be hidden.

Increased incidence of vulvovaginal candidiasis caused by Candida glabrata in Jordan.

Due to the rising importance of Candida glabrata and other non-albicans Candida as principle human opportunistic pathogens, 356 women with abnormal vaginal discharge who attended a private obstetrics and gynecology clinic in Amman, Jordan, between January 1999 and February 2001 were examined. The isolation rate of Candida spp. from high-vaginal swabs was 44.9%. CHROMagar Candida and conventional mycological methods identified six isolated Candida spp., including C. albicans, C. glabrata, C. tropicalis, C. parapsilosis, C. krusei, and C. kefyr. The percentages of C. albicans, C. glabrata, and C. tropicalis isolates were 43.1%, 32.5%, and 8.1%, respectively. C. albicans was isolated in combination with C. tropicalis and C. krusei in two patients. Statistical analysis of the present results clearly show an increase in the incidence of vulvovaginal candidiasis caused by C. glabrata in the two study periods, 1994-1996 and 1999-2001 (P = 0.0186). In contrast, comparing the proportions of vulvovaginal candidiasis caused by C. albicans in the two periods, there was no significant difference. These results may have significant clinical implications, as C. glabrata are innately less susceptible to most antifungal agents than C. albicans; these findings support viewing this organism as a major pathogen.

Association of Mycoplasma hominis and Ureaplasma urealyticum with some indicators of nonspecific vaginitis.

The purpose of this study was to determine the isolation rates of Mycoplasma hominis and Ureaplasma urealyticum from three populations of women and also to relate the presence of these microorganisms with some indicators of nonspecific vaginitis. Three hundred vaginal swabs were taken from delivery, pregnant and control (not pregnant) women. Cultures were done in E broth supplemented with arginine or urea. M. hominis was isolated in 5% at delivery, 12% from pregnant and 5% from control women and U. urealyticum was isolated in 21%, 31% and 28% respectively. There was statistical difference in the isolation rate of M. hominis in pregnant women respect to the other groups. Both microorganisms were more frequently isolated in women with acid vaginal pH, amine-like odor in KOH test, clue cells and leucorrhea. M. hominis was isolated in 17% and U. urealyticum in 52% from women with nonspecific vaginitis. M. hominis was isolated in 2% and U. urealyticum in 13% from women without nonspecific vaginitis. Although the presence of clue cells and amine-like odor in KOH test have relationship with Gardnerella vaginalis, these tests could also suggest the presence of these mycoplasmas.

Patologías cervicovaginales en una población de pacientes ginecológicas / Cervicovaginal pathologies in a gynecologic patients population

Se realizó un estudio prospectivo para determinar la prevalencia de patologías cervico-vaginales en un centro médico del sector privado, Santo Domingo, República Dominicana, durante el período Julio del 1993 a Julio del 1994 en la parte oriental de Santo Domingo; de 200 mujeres se encontró que la edad de inicio de las relaciones sexuales fue de 16-23 años (74//); el 20.55//con primaria completa; el 70//no se había realizado papanicolau; el 68.5//tuvo un cónyugue; el 33//tuvo leucorrea; el 90//tuvo grado II de PAP; el 80//con inflamación leve. Cervix, vagina, patología

[Study of 3985 female genital smears from the Clinical Biology Center of the Pasteur Institute in Madagascar]. / Etude de 3985 prélèvements génitaux féminins effectués au Centre de Biologie Clinique de l'Institut Pasteur de Madagascar.

A microbiological study of 3985 cervico-vaginal swabs has been carried out on patients from Pasteur Institute of Madagascar, most of them suffering from leucorrhea. This puts forward the predominance of non-specific vaginitis as well as cervicitis caused by mycoplasmas.

Vaginal discharge in general practice--women's perceptions, beliefs and behaviour.

OBJECTIVES: To describe women's perceptions and beliefs about their vaginal secretion and to relate these to their behaviour with respect to complaints of vaginal discharge. DESIGN: A multi-practice study including questionnaires for women and doctors and a semi-structured interview study. SETTING: North Jutland County and Aarhus County, Denmark. SUBJECTS: 283 women with and 417 women without complaints of vaginal discharge answered a questionnaire about their vaginal secretion. Ten women with vaginal discharge took part in the in-depth interviews. RESULTS: 179/274 (65%) women with and 111/417 (27%) women without complaints of vaginal discharge were bothered by their usual secretion. In 54/269 (20%) women with complaints, the pelvic examination was normal. In 59/416 (14%) women without complaints, the doctor found an abnormal vaginal secretion. Most women complaining of vaginal discharge had an external locus of control in relation to their symptoms, but an internal locus of control in relation to health in general. Fear of having a serious disease or a sexually transmitted disease was the reason for the visit to the general practitioner in 164/281 (58%). CONCLUSION: Women's perceptions and beliefs about their vaginal secretion varied and were related to their health seeking behaviour. In addition to information about possible biological causes of vaginal discharge, the general practitioner should also actively seek information about the women's perception of normality and beliefs in relation to the symptoms she experiences.

Leucorréia em adolescentes: experiência do Centro de Assistência Integral à Saúde da Mulher (CAISM) / Leucorrhea in adolescents: an experience at the Centro de Assistência Integral à Saúde da Mulher (CAISM)

Através de um estudo retrospectivo procurou-se avaliar algumas características de 208 adolescentes com queixa de leucorréia, atendidas no Ambulatório de Ginecologia de Adolescentes do CAISM/UNICAMP durante o período de dezembro de 1984 a janeiro de 1989. Foram analisadas a idade, a idade à menarca, a idade a primeira relaçäo sexual, o estado civil, o uso de métodos anticoncepcionais, o ritmo menstrual, o motivo da consulta, os diagnósticos clínico e laboratorial. Observou-se a presença de flora bacteriana normal em 72,3 por cento das pacientes sem atividade sexual. Entre aquelas sexualmente ativas, a presenta de um agente etiológico específico foi confirmada em 65 por cento dos casos. Discute-se a importância da queixa quanto a sua freqüência e significado clínico para a paciente adolescente.

Gonorrhea in women prostitutes: clinical data and auxotypes, serovars, plasmid contents of PPNG, and susceptibility profiles.

Eighty-nine women prostitutes who underwent clinical and microbiologic examination were found to have gonococcal infection. The median age was 22; 92.1% were from urban areas. Nearly all the women prostitutes refrained from barrier methods (92.1%) and had contact with several partners (91.0%). The most frequent clinical findings were leukorrhea (50.6%), cervicitis (20.2%), and pelvic inflammatory disease (PID) (18.0%). Eighty-one women prostitutes (93.1%) had experienced a previous STD, with Chlamydia trachomatis (34.8%), Trichomonas vaginalis (30.3%), Neisseria gonorrhoeae (29.2%), and Ureaplasma urealyticum (23.6%) as the most frequent microorganisms isolated. Microorganisms associated with N. gonorrhoeae were isolated, mainly T. vaginalis (40.4%), C. trachomatis (31.5%), and Mycoplasma hominis (21.3%). For N. gonorrhoeae, the most frequent auxotypes were prototrophic (67.4%) and Proline (Pro)-dependent (14.6%); 2.2% of the strains were non-auxotypable. Beta-lactamase production was detected in three strains (3.4%) belonging to the auxotype/serovar: Lys/IA, Prototrophic/IB, and Pro/IB. The two former produced the 3.2-MDa "African" plasmid; the latter produced two plasmids (the 4.5-MDa "Asian" and the 24.5-MDa transfer plasmid.

[Infections by Mycoplasma hominis and Ureaplasma urealytycum in vaginal discharge. Incidence and treatment]. / Infections à Mycoplasmes hominis et Ureaplasma urealytycum dans les écoulements vaginaux. Fréquence et traitements.

This report summarizes the studies carried out on 100 patients who were examined for vaginal discharge. The following observations were made: Mycoplasma hominis in 13.59% of the cases, Ureaplasma urealytycum in 8.73% of the cases, that is, the presence of at least one of these microorganisms in 22.32 of the cases. All these infections were treated by tetracyclines administered in appropriate doses.

Patients with vaginal discharge in general practice.

In a multi-practice study, 80 general practitioners registered 327 patients with spontaneous complaints of vaginal discharge. Forty-eight percent of the patients were between 20 and 29 years of age, compared with 20% in the general female population (p less than 0.001). An increase in discharge was reported by 89% of the women, itching by 53%, and malodour by 38%. More than one symptom was reported by 61%. The symptoms present were mutually independent and no correlation was found with age. Seventy-six percent of women 25 years or older had had earlier instances of vaginal discharge. In patients aged 15-19, 60% had experienced earlier episodes. Male consort symptoms were reported by 14% of patients less than 25 years old and by 7% of the patients 25 years or older (p less than 0.05). Symptoms had persisted for one week or less in 36% of the women, for between 1 and 2 weeks in 27%, and for more than one year in 5%.

The prevention of sexually transmitted diseases which affect fertility: methodological problems and initial results.

Sexually transmitted diseases and their consequences for fertility are currently a major preoccupation in public health. A joint research project is being carried out in France to develop an STD prevention program and then to implement it experimentally to evaluate its efficiency. It includes 2 phases: a feasibility phase, currently concluded, and an active phase, a community randomized trial. The aim of the feasibility phase was to test the research methods and tools and to act as a basis for the design of the prevention program. It measured the incidence of discharge (men and women) at a one-year interval and patient characteristics. Participating physicians were GPs in a French administrative department near Paris. Between the two measurements, information and sensitization actions were carried out in the same department among health professionals and the general public. The results show that the incidence of discharge (chosen here as indicators of STDs) in daily general medical practice is low, of the order of 6 cases per 1000 consultations. The community randomized trial will now be conducted in 6 French administrative departments, randomly divided into 3 treated departments, benefiting from a prevention campaign, and 3 controls, where no actions will be undertaken, and its results will be used in a national STD prevention campaign.

PIP: The complications of sexually transmitted diseases -- epididymitis in men and pelvic inflammatory disease in women -- result in 12,000 cases of infertility a year in France. It is therefore necessary to implement a program for the prevention of sexually transmitted diseases in France. The 1st step in such a program must be a feasibility study to determine the level of participation of general practitioners and the suitability of the questionnaires. The feasibility study was carried out in 2 steps, one in 1984 and a similar one in 1985. In each year, during a 4-week period, 57 participating doctors filled out questionnaires for each patient consulting for leucorrhea or urethral discharge. During the year between the studies, information brochures on sexually transmitted diseases were produced for doctors and the public. In 1984, the physicians noted 154 cases of leucorrhea and urethral discharge; in 1985, they noted 121 cases, an average of 6 cases/1000 patients. Of the 275 cases, 141 were in men, 134 in women. Only 4% of the men and 9% of the women were under 20, indicating that young patients go to a free health clinic rather than to private practitioners. Over 1/2 of the men, but only 1/5 of the women had multiple sexual partners, and 1/2 the patients were consulting for a recurrence. Bacteriological screening showed that the commonest organisms in the male infections were Gonococcus and Chlamydia trachomatis, while in women mycoses were more prevalent. The feasibility study showed that general practitioners cooperated and that the quality of the data was good. The 2nd phase of the study, a community randomized trial, is currently being conducted in 6 French administrative departments, 3 for treatment and 3 to act as controls. In each department 50 physicians are participating. All available information will be disseminated in the 3 treatment departments for 3 months after beginning the experiment.

Flujo vaginal: etiologia en una unidad intermedia de salud / Vaginal discharge: etiology in a health unit

En una serie de 584 mujeres que consultaron por flujo vaginal a una Unidad Intermedia de Salud se hallo que la entidad mas frecuente era la vaginosis bacteriana (vaginitis inespecifica o por Gardnerella vaginalis) con un 34,8% seguida por la candidiasis (9,4%) y la tricomoniasis (4,5%); hubo tambien infecciones mixtas (7,2%); la candidiasis, la tricomoniasis y las infecciones mixtas, pero no la vaginosis bacteriana, fueron mas frecuentes en mujeres embarazadas; se hace enfasis en la facilidad de diagnosticar vaginosis bacteriana en el laboratorio corriente con base en criterios de muy facil determinacion