Co-infection with genital gonorrhoea and genital chlamydia in female sex workers in Yunnan, China

An observational study on prevalence of co-infection with gonorrhoea and chlamydia was conducted among female sex workers (FSWs) in Kunming, China.A total of 505 FSWs participated in the study. All eligible participants gave informed consent. Demographic, behavioural and clinical information of the participants was gathered by direct structured interviews. Tampon swabs were collected to test for Chlamydia trachomatis and Nesseria gonorrhoeae. One-hundred and twenty-four (24.6%) FSWs were co-infected with these two pathogens. Of the 191 FSWs with gonorrhea, 124 (64.9%, 95% confidence interval [CI] = 57.9-71.3%) were co-infected with chlamydia which was significantly higher than the proportion (41.9%, 95% CI = 36.4-47.6%) co-infected with gonorrhoea among 296 FSWs with chlamydia (P < 0.001). Only 47 of 191 (24.6%) FSWs with gonococcal infection and 28 of 124 (22.6%) with co-infection with gonorrhoea and chlamydia reported vaginal discharge. The results of the study justify the recommendation in the national sexually transmitted disease (STD) guidelines that patients infected with gonorrhoea also be treated routinely with an anti-chlamydial regimen. However, a periodic mass treatment may be considered in some circumstances in STD control programmes to rapidly reduce the infections in this population.

Hydrogen peroxide-producingLactobacilliin the vaginal flora of pregnant women with preterm labor with intact membranes

OBJECTIVES

To investigate the role of vaginal infection in preterm delivery, we studied characteristics of vaginal discharge related to hydrogen peroxide-producing Lactobacilli.

METHODS

Vaginal specimens were obtained from 66 women with normal pregnancy and 30 women with preterm labor with intact membranes. pH, leukocyte counts on wet smear, and scores by Nugent criteria on Gram stain were measured. Lactobacilli were tested for their production of hydrogen peroxide.

RESULTS

Leukocyte levels in wet smears and Nugent scores of Gram-stained smear of women with preterm labor with intact membranes were significantly higher than those of normal pregnant women (P<0.01, P<0.05). Hydrogen peroxide-producing Lactobacilli levels in the vaginal flora of women with preterm labor with intact membranes were significantly lower (P<0.01).

CONCLUSION

Distribution of hydrogen peroxide-producing Lactobacilli in vaginal flora as defense factors for infection may have an important role in the pathophysiology of preterm labor.

Prevalence and antibiotic susceptibility of genital Mycoplasma hominis and Ureaplasma urealyticum in a university hospital in Turkey

This study aimed to assess the colonization prevalence and antibiotic susceptibility of genital Ureaplasma urealyticum and Mycoplasma hominis in a teaching hospital, in Turkey. A total of 382 sexually active women with abnormal vaginal discharge were included in the study. Samples that were obtained with cotton swabs were microbiologically analyzed for U. urealyticum and M. hominis, together with antimicrobial susceptibility to doxycycline, ciprofloxacin, ofloxacin, erythromycin, josamycin, pristinamycin, and tetracycline. Ureaplasma urealyticum was detected in 185 (48.4%) cultures, and M. hominis in 17 (4.4%). Eight (2.1%) cultures were positive for both. Resistance of M. hominis to doxycycline, ciprofloxacin, ofloxacin, erytromycin, josamycin, pristinamycin and tetrascycline was 5.9%, 17.6%, 41.2%, 88.2%, 5.9%, 5.9% and 11.8%, respectively. Resistance to doxycycline, ciprofloxacin, ofloxacin, erytromycin, josamycin, pristinamycin and tetrascycline in U. urealyticum isolates was 1.6%, 40.5%, 58.4%, 54.0%, 1.6%, 8.1% and 13.5%, respectively. Both U. urealyticum (94.1%) and M. hominis (96.2) were most sensitive to josamycin, and most resistant to erytromycin (U. urealyticum 54.0%, M. hominis 88.2) and ofloxacin (U. urealyticum 58.4%, M. hominis 41.2%). As a result, the rate of U. urealyticum and M. hominis was found to be 48.4% and 4.4%, respectively. We conclude that doxycycline may be used in empirical treatment of genital tract infections in sexually active women.

Clinical characteristics of vaginal discharge in bacterial vaginosis diagnosed by Nugent's criteria

PURPOSE OF INVESTIGATION

To determine which clinical signs have an important contribution in bacterial vaginosis (BV) diagnosed by Nugent's criteria.

METHODS

This was a cross-sectional study of 58 women undergoing vaginal examination at Hayashi women's clinic, Hyogo Prefecture. Characteristics of vaginal discharge (color, amount, odor, and pH level) and the number of clue cells were compared among normal, intermediate, and BV groups. BV was diagnosed by using Nugent's criteria.

RESULTS

The incidence of BV in our study population was 25.9%. Compared to the non-BV group, women in the BV group were found more often to have yellowish color and a moderate amount of discharge (66.67% vs 33.33%, NS; 55.56% vs 44.44%, NS), odorous discharge (100% vs 0%, p < 0.05) and furthermore, pH level and the number of clue cells were significantly higher.

CONCLUSION

Odor, pH level and the number of clue cells in the vaginal discharge were helpful clinical signs for early detection of BV diagnosed by Nugent's criteria.

[Case of endometrial tuberculosis]

A 66-year-old woman was referred to our hospital because of lochiorrhea. Uterus MRI and ultrasonography showed hydrometra. Endometrium biopsy revealed epithelioid cell granuloma, and vaginal discharge and endometrium culture was positive for M. tuberculosis. She was diagnosed as endometrial tuberculosis. After treatment with INH, RFP, and EB for 9 months, she recovered.

Frequency and diagnosis of bacterial vaginosis

OBJECTIVE

To determine the frequency of bacterial vaginosis (BV) in women with vaginal discharge, and to compare different diagnostic tests for its diagnosis.

DESIGN

Cross-sectional study.

PLACE AND DURATION OF STUDY

The Aga Khan University Hospital from June 1998 to May 2000.

PATIENTS AND METHODS

All women attending the Obstetrics and Gynecology clinics at The Aga Khan University Hospital, with the complaints of vaginal discharge, were examined with the help of a speculum. The vaginal pH was measured, samples for bacterial cultures were obtained. A slide was prepared for the gram's stain and Whiff-test was also performed. BV was diagnosed, when the vaginal discharge fulfilled at least three of the composite clinical criteria (Amsel's criteria), a standard method for the diagnosis of bacterial vaginosis: homogenous (pasty) discharge, pH more than 4.5, positive Whiff-test and the presence of clue cells.

RESULTS

The frequency of BV was observed to be 16.1% . The culture for Gardnerella vaginalis was compared with the composite clinical criteria. The sensitivity, specificity, positive and negative predictive values of the culture, calculated for the diagnosis of BV were 93.8%, 70%, 37.7% and 98% respectively.

CONCLUSION

The use of laboratory tests in conjunction with clinical findings is necessary for diagnosis of BV. The composite clinical criteria for the diagnosis of BV are rapid, reliable and inexpensive method.

Treatment of chronic endometritis in dairy cows with an intrauterine application of enzymes. A field trial

The use of proteolytic enzymes has been established in the non-antibiotic treatment of mastitis in dairy cattle. The objective of this study was to evaluate, if enzymes are efficacious in the treatment of chronic endometritis. In a controlled field trial, cows with vaginal discharge 21-27 days in milk (DIM) were randomly assigned to two treatment groups. Endometritis was classified into three categories, depending on the type of vaginal discharge: clear mucus with flakes of pus (E1), mucopurulent discharge or fluctuating contents in the uterus (E2), and purulent discharge (E3). In group ENZYMES (n=191), cows received an intrauterine treatment with a salve containing the enzymes trypsin (16 mg), chymotrypsin (16 mg), and papain (8 mg). Cows in group PGF (n=225) were treated with 0.5mg of cloprostenol. Cows that did not show any clinical signs of chronic endometritis were regarded as healthy control group (HC, n=699). In groups ENZYMES and PGF, all cows were re-examined 35-41 DIM. In group ENZYMES, cows were re-treated with enzymes if signs of endometritis were found, while in group PGF all cows received a second dose of cloprostenol, regardless of their clinical findings. Cure rate after the first treatment, defined as the absence of vaginal discharge at the re-examinations, was 59.7 and 68.0% in groups ENZYMES and PGF, respectively (P>0.05). Reproductive performance measures showed no significant differences between the two treatment groups. Service rate was significantly lower for ENZYMES and PGF, respectively, compared to HC. Conception rates to all services and percentages of cows pregnant by 250 DIM were significantly lower in group ENZYMES compared to HC, while no further differences were found between PGF and HC. In both treatment groups, cure rate and reproductive performance measures were better for cows categorized E1 or E2, than for cows categorized E3, respectively. Conception rate to all services for cows with endometritis category E1 was higher in group PGF than in group ENZYMES (P<0.05). The results of this field trial suggest that prostaglandin F(2alpha) is still the treatment of choice for chronic endometritis in dairy cattle.

Why do women complain of vaginal discharge? A population survey of infectious and pyschosocial risk factors in a South Asian community

BACKGROUND

Vaginal discharge is a common complaint, particularly among women in Asia. Although presumed to be caused by reproductive tract infections (RTIs), the association between the complaint and the presence of RTIs is weak. This study aimed to investigate the risk factors of the complaint of vaginal discharge.

METHODS

We conducted a community-based survey of 3000 women aged 18-50 years, randomly sampled from a population in Goa, India. Women who gave informed consent were invited to participate in a structured interview, which elicited data on the primary outcome (the experience of current abnormal vaginal discharge) and psychosocial exposures: gender adversity; symptoms of somatoform disorders; and common mental disorders (CMD). All women were required to provide vaginal and/or urine samples for diagnosis of RTIs using gold standard laboratory tests. Risk factors were analysed using logistic regression with the binary outcome of the complaint of vaginal discharge.

RESULTS

Of the 2494 women (83%) who agreed to participate, 14.5% complained of having an abnormal vaginal discharge. Stress was the most common causal attribution for the complaint. The final multivariate model found that high scores for CMD (OR 2.16, 1.4-3.2) and somatoform disorders (6.23, 4.0-9.7) and the use of an intrauterine contraceptive device (1.86, 1.0-3.4) were independently associated with the complaint. Low literacy (0.54, 0.4-0.8) and age >40 years (0.29, 0.2-0.4) were associated with a reduced risk. RTI were not associated with the complaint (1.24, 0.9-1.6).

CONCLUSIONS

Psychosocial factors have the strongest association with the complaint of vaginal discharge. Syndromic management algorithms need refinement so that women with complaints that are non-infectious in aetiology are offered psychosocial interventions.

A comparative study of clinical management strategies for vaginal discharge in family planning and genitourinary medicine settings

OBJECTIVE

To compare strategies for management of women with vaginal discharge in genitourinary medicine (GUM) and family planning (FP) settings.

METHODS

The setting was a centre housing both FP and GUM departments within a primary care trust in Scotland. The study participants were 200 women presenting with vaginal discharge. A randomised, controlled, crossover design was employed. Strategies typical of FP and GUM were performed on every participant in a randomised sequence. Day 1 diagnoses were made by the FP strategy (history and examination) and the GUM strategy (nearpatient microscopy added). Day 7 results were obtained from final analysis of all specimens. Days 1 and 7 results were compared with the reference standard provided by all the test results. The main outcome measures were incorrect diagnoses on Days 1 and 7.

RESULTS

On Day 1 the FP strategy resulted in significantly more incorrect diagnoses than the GUM strategy when compared with the reference standard (73 vs 32; p <0.001). On Day 7 the GUM strategy resulted in significantly more incorrect diagnoses than the FP strategy when compared with the reference standard (32 vs 17; p = 0.019).

CONCLUSIONS

Vaginal discharge can be managed effectively in community settings such as FP and primary care. The addition of near-patient microscopy produces a more accurate immediate diagnosis. The addition of a high vaginal swab for culture produces a more accurate final diagnosis. The costs of on-site microscopy must be considered.

Variation in Nugent score and leukocyte count in fluid collected from different vaginal sites

OBJECTIVE

To assess the variability in Nugent score and leukocyte count measured in vaginal secretions collected from 3 vaginal sites.

METHODS

Fifty pregnant women at less than 20 weeks of gestation were consecutively recruited at the time of their first prenatal visit. Three vaginal smears were collected from each woman, 1 from the posterior fornix, 1 from the mid-lateral wall, and 1 from the introitus. Smears were Gram stained and evaluated for bacterial vaginosis using Nugent's criteria. Each smear was classified as positive for bacterial vaginosis if the Nugent score was 7 or greater, intermediate if the score was between 4 and 6, and negative if the Nugent score was 3 or less. A mean leukocyte value was obtained for each slide by evaluating 5 fields under oil immersion. Repeated-measures analysis of variance was used to compare mean Nugent scores and leukocyte counts across sites.

RESULTS

The sample consisted of mostly African-American, young, low-income women in their first trimester of pregnancy. Forty-seven percent were bacterial vaginosis-positive (Nugent score 7 or greater). Mean Nugent scores (+/- standard deviation) across the vaginal sample collection sites were similar: posterior fornix = 4.2 (4.4); mid-lateral wall = 4.2 (4.5); introitus = 4.2 (4.6). In contrast, the mean leukocyte count varied significantly across vaginal sample collection sites: 2.5 (4.2); mid-lateral wall = 2.8 (4.4); introitus = 6.5 (8.6) (F = 11.26 (1, 47.5); P = .002).

CONCLUSION

Leukocyte counts vary according to the site from which vaginal secretions were obtained, with the highest leukocyte count in samples obtained from the introitus. Bacterial vaginosis diagnosis by Nugent score does not vary by site of sample collection.

[Frequency of vaginal infections in pregnant women in the Department of Perinatology and Gynaecology in Zabrze]

OBJECTIVES

The analysis of vaginal infections in pregnant women admitted to the Department of Perinatology and Gynaecology in Zabrze, from January 2001 to September 2003.

MATERIALS AND METHODS

They were screened for BV, candidiasis and trichomoniasis. 450 pregnant women (the age of pregnancy 25 +/- 9 weeks gestation) were examined for the presence of these microorganisms in the vagina. Diagnosis was based on symptoms, pH measurement and microscopic examination of the vaginal discharge.

CONCLUSIONS

The most common vaginal infection was candidiasis--188 (42%), 86 (19 %) women had BV, 17 (4%) Trichomonas vaginalis and 159 (35%) patients had normal vaginal flora.

Abnormal vaginal discharge: what does and does not work in treating underlying causes

Antifungal medications for intravaginal use have been available in the United States for more than a decade. Women may be inclined to self-diagnose yeast infections with any vaginal discharge or other vulvovaginal symptoms that they deem abnormal. As we saw in the first part of this article, "Abnormal vaginal discharge: Using office diagnostic testing more effectively" (J Fam Pract 2004; 53[10]:805-814), abnormal discharge is more likely to be bacterial vaginosis or no pathogen at all. Potential delay in diagnosis and treatment of a sexually transmitted disease is also a concern. Increasing resistance of Candida sp. to imidazoles is associated with indiscriminate use of over-the-counter products.

Sorting out common causes of abnormal vaginal discharge

A chief complaint of abnormal vaginal discharge requires a broad differential diagnosis of both infectious and noninfectious causes. The patient's history and the physical exam should guide the choice of laboratory studies, and a complete physical exam that includes a thorough examination of both the external and internal genitalia will yield additional important information. Empirical treatment is unacceptable, considering the low cost of pH testing and saline and KOH preps compared to the cost of inappropriate treatment, repeat office visits, and the likelihood that eventually these tests will need to be performed. Some of the infectious causes of abnormal discharge may lead to serious complications with inappropriate treatment.

How is the high vaginal swab used to investigate vaginal discharge in primary care and how do GPs' expectations of the test match the tests performed by their microbiology services?

OBJECTIVES

To describe the management of vaginal discharge in general practice, with particular regard to the use of the high vaginal swab (HVS), and to compare GPs' expectations of this test with the processing and reporting undertaken by different laboratories.

METHODS

A postal questionnaire survey of 2146 GPs in the North Thames area and postal questionnaire study of the 22 laboratories serving the same GPs were carried out. GPs were asked how they would manage a young woman with vaginal discharge and what information they would like on an HVS report. Laboratories were asked how they would process and report on the HVS sample from the same patient.

RESULTS

Response rate was 26%. 72% of GPs would take an HVS and 62% would refer on to a genitourinary medicine (GUM) clinic. 45% would offer empirical therapy and 47% of these would treat for candida initially. 75% of GPs routinely request "M,C&S" on HVS samples but 55% only want to be informed about specific pathogens. Routine processing of HVS samples varies widely between laboratories and 86% only report specific pathogens. 78% of GPs would like to be offered a suggested diagnosis on HVS reports, and 74% would like a suggested treatment. 43% of laboratories ever provide a diagnosis, and 14% provide a suggested treatment.

CONCLUSIONS

GPs frequently manage vaginal discharge and most of them utilise the HVS. GPs' expectations of the test are not well matched to laboratory processing or reporting of the samples.

Relationship between the morphology of Candida cells and vaginal discharge

The aim of this study was to detect whether there is a correlation between the dimorphic pattern of Candida cells and various types of vaginal discharge. For this purpose, 2861 Papanicolaoustained cervicovaginal smears were examined cytologically and 265 of 2861 (9.26%) were diagnosed as having Candida cells. The 88 of 295 (29.83%) were identified as having blastospores only, 135 of 295 (45.76%) as having "hyphae only", and 47 of 295 (15.93%) as having both blastospores and hyphae of candida cells. There was a significant correlation between the type of candida cells and vaginal discharge (p < 0.05). The white-cheesy type vaginal discharge was the most prominent symptom for the observation the "hyphae only" following "blastospores only" and both blastospores and hyphae of Candida cells. It was suggested that hyphael form of Candida cells is the most pathogenic pattern and white-cheesy vaginal discharge is a marker for the presence of hyphael form in the vaginal mucosa.

Evaluation of vaginal complaints

CONTEXT

Vaginal symptoms are one of the most common reasons for gynecological consultation. Clinicians have traditionally diagnosed vaginal candidiasis, bacterial vaginosis, and vaginal trichomoniasis using some combination of physical examination, pH, the wet mount, and the whiff test.

OBJECTIVES

To evaluate the role of the clinical examination and determine the positive and negative likelihood ratios (LRs) for the diagnosis of vaginal candidiasis, bacterial vaginosis, and vaginal trichomoniasis.

DATA SOURCES

Using a structured literature review, we abstracted information on sensitivity and specificity for symptoms, signs, and office laboratory procedures. We chose published (1966 to April 2003) articles that appeared in the MEDLINE database and were indexed under the combined search terms of diagnosis with vaginitis, vaginal discharge, candidiasis, bacterial vaginosis, and trichomoniasis.

STUDY SELECTION

Included studies of symptomatic premenopausal women seen in primary care settings. Tests were evaluated only if they would provide diagnostic information during the office visit and were compared with an acceptable criterion standard.

DATA EXTRACTION

All 3 authors extracted the data and computed sensitivity and specificity from each article independently. The absence of standard definitions for symptoms and signs made it impossible to combine results across studies.

DATA SYNTHESIS

Symptoms alone do not allow clinicians to distinguish confidently between the causes of vaginitis. However, a patient's lack of itching makes candidiasis less likely (range of LRs, 0.18 [95% confidence interval [CI], 0.05-0.70] to 0.79 [95% CI, 0.72-0.87]) and lack of perceived odor makes bacterial vaginosis unlikely (LR, 0.07 [95% CI, 0.01-0.51]). Similarly, physical examination signs are limited in their diagnostic power. The presence of inflammatory signs is associated with candidiasis (range of LRs, 2.1 [95% CI, 1.5-2.8] to 8.4 [95% CI, 2.3-31]). Presence of a "high cheese" odor on examination is predictive of bacterial vaginosis (LR, 3.2 [95% CI, 2.1-4.7]) while lack of odor is associated with candidiasis (LR, 2.9 [95% CI, 2.4-5.0]). Office laboratory tests, particularly microscopy of vaginal discharge, are the most useful way of diagnosing these 3 conditions.

CONCLUSIONS

The cause of vaginal complaints may be easily diagnosed when typical findings appear in microscopy. However, the poor performance of individual symptoms, signs, and office laboratory tests often makes it problematic to identify the cause of vaginal symptoms.

Prevalence of HIV among women with vaginal discharge in a gynecological clinic

OBJECTIVE

Vaginal discharge is a common complaint among women with sexually transmitted diseases (STDs) in Nigeria. Given the association between STDs and HIV and the alarming rise in the prevalence of HIV in Nigeria, we performed this study to determine the prevalence of HIV in patients with vaginal discharge.

STUDY DESIGN

Between April 2000 and August 2000, women who attended the Lagos University Teaching Hospital and complained of vaginal discharge were adequately counseled for HIV serotest. High vaginal/endocervical swabs and venous blood were taken for microbiological studies and HIV serotest, respectively.

RESULTS

Out of the 230 women counseled for HIV serotest 140 (60.9%) consented. The mean age of the 140 was 31.1+/-6.9 years (range 18-50 years). In 31 (22.1%), Candida albicans was isolated, in 26 Gardnerella vaginalis (18.8%), in 17 Staphylococcal spp. (12.1%); and E. coli, Trichomonas vaginalis, and Neisseria gonococcus in 7.9%, 4.3%, and 1.4%, respectively. Four (2.9%) of the 140 patients were HIV seropositive, and all had Candida albicans isolated. The prevalence of HIV among patients with Candida albicans was 12.9%. Association between HIV seropositivity and Candida albicans infection is significant (X2=14.48; p=0.002).

CONCLUSION

Candida albicans is a common cause of vaginal discharge among HIV-seropositive women in Lagos.

[Importance of the vaginal ecosystem examination in the first trimester of pregnancy]

OBJECTIVES

Vaginal ecosystem disturbances especially bacterial vaginosis are strongly associated with infectious complication during the course of pregnancy.

DESIGN

The aim of the study was the determination of the vaginal ecosystem examination for the diagnosis of the following infection: bacterial vaginosis, candidiasis and trichomoniasis in pregnant women in the first trimester of pregnancy.

MATERIALS AND METHODS

The studies included 106 randomly selected asymptomatic pregnant women in I trimester of pregnancy coming for gynaecological examination for the first time after cessation of menstruation were divided into two group: 56 primiparae and 50 multiparae. The diagnosis of BV was based on Amsel criteria concerning vaginal secretion. Trichomonas vaginalis was determined in wet vaginal smear. Candida albicans was detected in vaginal smear after addition of 10% KOH solution.

RESULTS

Out of 106 studied subjects in the first trimester of pregnancy, BV was detected in 17.9%, Candida albicans in 15.1%, Trichomonas vaginalis in 3.8%. The detectability of BV infection varied significantly between both groups of studied women (p < 0.001) while no correlation was found between the occurrence of Candida albicans and Trichomonas vaginalis infections.

CONCLUSION

Vaginal ecosystem screening in pregnant women makes possible under ambulatory conditions, to detect the following infections: BV, candidiasis and trichomoniasis. Determination of disturbances in vaginal ecosystem is simple and inexpensive, not requiring laboratory facilities for the assessment of vaginal infections.

Experimental Coxiella burnetii infection in pregnant goats: excretion routes

Q fever is a widespread zoonosis caused by Coxiella burnetii. Infected animals, shedding bacteria by different routes, constitute contamination sources for humans and the environment. To study Coxiella excretion, pregnant goats were inoculated by the subcutaneous route in a site localized just in front of the shoulder at 90 days of gestation with 3 doses of bacteria (10(8), 10(6) or 10(4) i.d.). All the goats aborted whatever the dose used. Coxiella were found by PCR and immunofluorescence tests in all placentas and in several organs of at least one fetus per goat. At abortion, all the goats excreted bacteria in vaginal discharges up to 14 days and in milk samples up to 52 days. A few goats excreted Coxiella in their feces before abortion, and all goats, excreted bacteria in their feces after abortion. Antibody titers against Coxiella increased from 21 days post inoculation to the end of the experiment. For a Q fever diagnostic, detection by PCR and immunofluorescence tests of Coxiella in parturition products and vaginal secretions at abortion should be preferred to serological tests.

Testing for genital gonorrhea infections in prepubertal girls with suspected sexual abuse

BACKGROUND

The medical diagnosis of child sexual abuse is based on a combination of factors, including disclosures by the child, specific physical examination findings and sexually transmitted infections. Genital infections with Neisseria gonorrhoeae (GC) are regarded as definitive evidence of sexual contact in children, but current microbiologic culture methods have low sensitivity for detecting vulvovaginal GC infections in prepubertal girls.

METHODS

To compare the three strategies of culture alone, nonculture alone (Gen-Probe PACE 2) and sequential testing for genital GC (nonculture followed by culture of nonculture positives), we conducted a decision analysis to identify optimal testing strategies using published test sensitivities, specificities and pretest probabilities of genital GC. We surveyed community child welfare professionals to determine values for each potential health outcome.

RESULTS

Sequential testing yielded a higher overall health outcome value (0.855) than culture (0.834) or nonculture methods (0.838). These results were insensitive to changes in GC prevalence, test characteristics and individual health outcome values over clinically important ranges. With a baseline prevalence of 10%, more children (4 per 100) with GC infection were missed by culture than were inaccurately labeled as having GC infection (0.5 per 100) by nonculture methods. Sequential testing yielded fewer false negative results (0.8 per 100) than culture and had no false positives.

CONCLUSIONS

With the use of clinical decision analysis, sequential testing using nonculture methods followed by culture was preferred to culture or nonculture methods alone in the evaluation of GC in prepubertal girls with genital discharge. Current recommendations for GC testing should be reassessed with clinical decision analysis as new test methods or strategies become available.

Vulvovaginitis in prepubertal girls

This retrospective study evaluated the clinical features and findings in bacterial cultures and in microscopic examination of vaginal secretions in 80 prepubertal girls, aged 2-12 years, with vulvovaginitis. Vaginal secretions were obtained directly from the vagina with a sterile catheter carefully inserted into the vagina. Pathogenic bacteria were isolated in 36% of cases. In 59% of these cases the isolated pathogen was group A beta-haemolytic streptococcus. Candida was not found in any of the patients. The finding of leucocytes in vaginal secretions as an indicator for growth of pathogenic bacteria had a sensitivity of 83% and a specificity of 59%. Antimicrobial treatment should therefore be based on bacteriological findings of vaginal secretions and not on the presence of leucocytes alone.

[Some specific features of vaginal microflora depending on ecological factors]

In 75 female residents of Vladikavkaz, aged 18-45 years, who had applied to the gynecological department with complaints of vaginal discharge, the qualitative and quantitative composition of vaginal microflora was studied. All these women were divided into 2 groups: group 1 including 38 women living in ecologically unfavorable districts of the city and group 2 including 37 women living under ecologically favorable conditions. The relationship between the ecological situation of the districts of residence and vaginal microflora in women of the reproductive age was established. Unfavorable exogenous factors were found to lead to the development of vaginal dysbacteriosis: a sharp decrease in the amount of lactoflora or its complete absence accompanied by increased amount of staphylococci, enterococci, Escherichia coli, Proteus, Klebsiella and yeast-like fungi of the genus Candida.