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Clinical utility of measuring white blood cells on vaginal wet
mount and endocervical gram stain for the prediction of chlamydial and
gonococcal infections.
Sexually Transmitted Diseases 2000;27(9):530-538.
Moore SG, Miller WC, Hoffman IF, Fox KK, Owen-O'Dowd J, McPherson T, Privette
A, Schmitz JL, Leone PA.
Abstract
BACKGROUND: White blood cells on endocervical Gram stain and vaginal wet mount
are frequently used to predict chlamydial and gonococcal infections. Previous
studies provide conflicting evidence for the clinical utility of these tests.
GOAL: To evaluate the clinical utility of measuring white blood cells on
vaginal wet mount and endocervical Gram stain for the prediction of chlamydial
infection and gonorrhea. STUDY DESIGN: Women undergoing pelvic examinations
at 10 county health department family planning and sexually transmitted disease
clinics were tested for chlamydial infection by ligase chain reaction assay
(n = 4550) and for gonorrhea by culture (n = 4402). Vaginal wet mount and
endocervical Gram stains were performed in county laboratories at the time
of examination. RESULTS: The prevalences of chlamydial infection and gonorrhea
were 8.8% and 3.2%, respectively. For detection of chlamydial or gonococcal
infection, the likelihood ratio was 2.85 (95% CI, 2.10-3.87) for > 30
white blood cells on vaginal wet mount and 2.91 (95% CI, 2.07-4.09) for > 30
white blood cells on endocervical Gram stain. Similar results were seen for
individual diagnoses either of chlamydial infection or of gonorrhea. CONCLUSION:
Vaginal wet mount and endocervical Gram stain white blood cells are useful
for the presumptive diagnosis of chlamydial infection or gonorrhea only in
settings with a relatively high prevalence of infection or when other predictors
can increase the likelihood of infection.