Clinical and Microscopic Signs of Cervicitis and Urethritis: Correlation with Chlamydia trachomatis Infection in Female STI Patients

Abstract

Chlamydia trachomatis is among the most prevalent genital infections and is an important cause of tubal factor infertility. The majority of infected females are asymptomatic. Evidence on the reliability of signs of inflammation used to predict chlamydia in female patients is inconsistent. This study examined associations between criteria routinely used in many Scandinavian sexually transmitted infection (STI) clinics and a positive chlamydia test in a high-prevalence population. Clinical and microscopic signs of cervicitis and urethritis were recorded in 99 women attending due to chlamydia infection in a sexual partner. Mucopurulent cervical discharge, easily induced bleeding from the cervix, and more polymorpho-nuclear cells than epithelial cells in vaginal wet smear all correlated significantly with a positive Chlamydia trachomatis test (odds ratios: 3.4, 4.0 and 4.8, respectively). Increased numbers of polymorphonuclear leucocytes (>30 and ≥ 5 respectively) in stained cervical and urethral smears were not significantly correlated with chlamydia infection. Hence, routine collection of cervical and urethral smears in female STI patients is questionable.

Comparison of clinical performance of antigen basedenzyme immunoassay (EIA) and major outer membrane protein (MOMP)-PCR for detection of genital Chlamydia trachomatis infection

“…As shown in studies from Tehran and Lublin, Poland, women with cervicitis are more likely to have been previously infected with Chlamydia ( 14 , 17 , 26 ) . Urethritis and cervicitis may lead to complications including PID, ectopic pregnancy, tubal factor infertility and reactive arthritis ( 38 ). Based on the available evidence, approximately 20% of women with chlamydial lower genital tract infection will develop PID, and less proportion will develop other adverse pregnancy outcomes ( 39 ).…”

PCR diagnostics of Chlamydia trachomatis in asymptomatic infection by women

“…Berntsson et al tested 99 women whose partners received a positive result for Chlamydia trachomatis. Using genetic methods they received positive results in 53 out of 99 women (53.5%); of the women infected with Chlamydia trachomatis half the women did not declare any clinical symptoms, but the other patients experienced dysuria and vaginal discharge [16].…”

The Role of Polymorphonuclear Leukocyte Counts from Urethra, Cervix, and Vaginal Wet Mount in Diagnosis of Nongonococcal Lower Genital Tract Infection

“…A study from Gothenburg conducted on 99 females attending due to partner notification of C. trachomatis found 53 tested positive for Ct and showed that mucopurulent cervical discharge, cervical bleeding, and finding WBCs> epithelial cells in the vaginal wet mount were all significantly associated with a positive Ct result, whereas an increased number of PMNLs in the stained smears from cervix and urethra were not [ 14 ]. However, in the Gothenburg study, plastic loops were used for urethral smear sampling, instead of a metal spatula as used by Falk et al and by Moi et al [ 4 , 12 , 13 ], which may explain the difference.…”

“…However, the thickness and concentration of a vaginal stained smear or wet mount is difficult to standardize. In our study we defined purulent wet mount as more WBCs than epithelial cells in phase-contrast microscopy of a saline vaginal wet mount [ 14 ].…”