CHLAMYDIAL CERVICITIS - TESTING THE PRACTICE GUIDELINES FOR PRESUMPTIVE DIAGNOSIS

Objective: To test the recommendation from the Canadian guidelines for sexually transmitted diseases (STDs) that mucopurulent endocervical d ischarge and 10 or more polymorphonuclear leukocytes (PMNs) per high-p ower field of a Gram-stained endocervical smear or, when Gram staining is not possible, the presence of endocervical discharge and one of ed ema, erythema or induced mucosal bleeding of the cervix can be conside red diagnostic for chlamydial cervicitis. Methods: A total of 596 cons ecutive women attending 2 family planning clinics for routine care und erwent vaginal speculum examination and were tested for Chlamydia trac homatis and Neisseria gonorrhoeae. PMN counts from Gram-stained endoce rvical smears and the presence or absence of putative indicators of ch lamydial infection were recorded. Results: The prevalence of chlamydia l cervicitis was 6.2% (37/596), and no women tested positive for N. go norrhoeae. Presumptive diagnosis of chlamydial cervicitis based on the guidelines criteria of mucopurulent endocervical discharge and 10 or more PMN per high-power microscopic field had a sensitivity and specif icity of 18.9% and 97.0% respectively, a positive predictive value of 29.2% and a positive likelihood ratio (LR) of 6.2 (p = 0.003). Presump tive diagnosis based on endocervical discharge with edema, erythema or induced mucosal bleeding of the cervix had a sensitivity and specific ity of 43.2% and 80.0% respectively, a positive predictive value of 12 .5% and a positive LR of 2.2 (p = 0.002). In the presence of bacterial vaginosis or vaginitis, the LR for the criteria of mucopurulent endoc ervical discharge and 10 or more PMN per high-power field was 5.4 (p = 0.04), whereas the LR was 4.3 (p = 0.10) if bacterial vaginosis and v aginitis were absent. Conclusions: In this setting, the practice of ma king a presumptive diagnosis of chlamydial cervicitis on the basis of the criteria given in the Canadian STD guidelines was not supported.