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 discharge and 10 or more polymorphonuclear leukocytes (PMNs) per high-power field of a Gram-stained endocervical smear or, when Gram staining is not possible, the presence of endocervical discharge and one of edema, erythema or induced mucosal bleeding of the cervix can be considered diagnostic for chlamydial cervicitis. METHODS: A total of 596 consecutive women attending 2 family planning clinics for routine care underwent vaginal speculum examination and were tested for Chlamydia trachomatis and Neisseria gonorrhoeae. PMN counts from Gram-stained endocervical smears and the presence or absence of putative indicators of chlamydial infection were recorded. RESULTS: The prevalence of chlamydial cervicitis was 6.2% (37/596), and no women tested positive for N. gonorrhoeae. 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 specificity 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). Presumptive diagnosis based on endocervical discharge with edema, erythema or induced mucosal bleeding of the cervix had a sensitivity and specificity 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 endocervical 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 vaginitis were absent. CONCLUSIONS: In this setting, the practice of making a presumptive diagnosis of chlamydial cervicitis on the basis of the criteria given in the Canadian STD guidelines was not supported.     

Dipstick leukocyte esterase activity in first-catch urine specimens. A useful screening test for detecting sexually transmitted disease in the adolescent male

Although sexually active female adolescents are often routinely screened for sexually transmitted diseases, indications for culturing adolescent males for sexually transmitted urethral infections are controversial. A study of 54 sexually active males (14 to 22 years old) was undertaken to assess the reliability of using dipstick leukocyte esterase activity in first-catch urine specimens to detect urethritis caused by Neisseria gonorrhoeae and Chlamydia trachomatis. Eighteen males had sexually transmitted diseases: N gonorrhoeae (nine patients), C trachomatis (eight patients), and N gonorrhoeae and C trachomatis (one patient). First-catch urine specimens with a 1+ (mild) or 2+ (moderate) reaction on dipstick testing had a leukocyte (WBC) count of 10 WBCs per high-power field or greater on microscopic analysis, with an 83% sensitivity, 100% specificity, a 100% positive predictive value, and a 92% negative predictive value for the presence of N gonorrhoeae, C trachomatis, or both. Clinical criteria for screening (urethral discharge, dysuria, or exposure to a sexually transmitted infection) plus a dipstick-positive first-catch urine specimen had a 94% sensitivity, 89% specificity, an 81% positive predictive value, and a 97% negative predictive value.     

Endocervical Chlamydia trachomatis infection in Canadian adolescents.

The highest prevalence rate of sexually transmitted chlamydial infection is among adolescent girls. To determine the rate among predominantly asymptomatic girls who were seen at a pediatric gynecology unit and to identify those at high risk we screened 541 such patients from Jan. 1 to Dec. 31, 1986, by means of direct fluorescent antibody testing; 422 (78.0%) were asymptomatic. The most common reason for presentation was a request for contraceptive advice (the reason for 59.2% of the patients). Of the 446 patients (82.4%) who were sexually active 66 (14.7%) had evidence of chlamydial infection; none of the 93 sexually inactive patients were infected. Neisseria gonorrhoeae was isolated from eight (1.5%) of the patients. The risk factors that correlated with chlamydial infection were abnormal vaginal discharge, abdominopelvic pain and an abnormal Papanicolaou test result. Because of the high morbidity rate associated with genital chlamydial infection and the high prevalence rate among adolescent girls, most of whom are asymptomatic, all sexually active teenagers should be screened.     

Urinary leukocyte esterase screening test for asymptomatic chlamydial and gonococcal infections in males

We evaluated the ability of the urinary leukocyte esterase test to predict culture-verified chlamydial and gonococcal urethritis among asymptomatic adolescent males. Nine hundred forty-eight sexually active males provided first-catch urine samples for esterase screening, and 76 (8%) tested positive (greater than or equal to 1+). Among 435 boys who agreed to undergo urethral culture, the esterase was positive in 66 (15%), Chlamydia trachomatis was isolated from 39 (9%), and Neisseria gonorrhoeae was isolated from 14 (3%). The sensitivity, specificity, and positive and negative predictive values for the esterase test were 72%, 93%, and 58% and 96%, respectively. Using the esterase test to screen asymptomatic males for urethritis, we identified 38 culture-verified infections that otherwise would have remained undetected. The urinary leukocyte esterase test is a noninvasive and cost-effective screening method to detect urethritis among asymptomatic adolescent males.     

219例阴道超声诊断阴道出血的临床价值分析

目的探讨超声在妇产科阴道出血性疾病中的诊断价值。方法选择2008年2月～2011年8月收治的阴道出血患者219例,对其分别进行阴道超声以及宫腔镜下取活检筛查,以判断超声对阴道出血性疾病的筛查效果。结果超声检查中,不同病变患者的子宫内膜厚度有明显的差异（P〈0．05）;阴道超声检查的敏感度、特异性、阴性预测率以及阳性预测率分别为91．84％、81．23％、93．21％及70．19％;其对癌前病变以及子宫内膜癌的敏感性、特异性、阴性预测率以及阳性预测率分别为100．00％、63．26％、35．32％、100．00％。结论阴道超声对阴道出血性疾病的筛查具有较好的敏感性以及特异性,具有较好的诊断参考价值。     

唾液酸酶测定对诊断细菌性阴道病价值的探讨

目的 :探讨唾液酸酶测定法诊断细菌性阴道病的价值。方法 :取阴道分泌物行 p H、氨试验、涂片找线索细胞 ;BVBlue唾液酸酶测定试验 ;阴道加德纳菌免疫荧光试验。结果 :BV Blue唾液酸酶试验的敏感性、特异性、阳性预期值、阴性预期值分别为 99.4 %、97.8%、97.0 %、99.6 %。 BV Blue试验在检测细菌性阴道病上和传统的 Amsel四步法试验相比无显著性差异 (χ2 =0 .0 8,P>0 .0 5 ) ,且不受阴道毛滴虫病、生殖器念珠菌病、淋病、支原体感染等的影响 (P>0 .0 5 )。结论 :采用 BV Blue唾液酸酶测定检测细菌性阴道病简便、快速、可靠、结果易判读 ,不失为一种临床上可行的好方法。     

淋病奈瑟氏菌三种检测方法的结果比较

目的：分析评价聚合酶链反应（PCR）、细菌培养、直接涂片染色3种方法检测淋病奈瑟氏菌（neisseria gonorrboeae,NG）的应用效果。方法：分别采用PCR检测法、细菌培养法、直接涂片染色法分别对366份女性阴道分泌物以及325份男性尿道分泌物进行检测,并对三种方法的阳性检测结果进行比较分析。结果：PCR检测180份女性阴道分泌物标本,NG-DNA阳性率为21.67%,150份男性尿道分泌物,NG-DNA阳性率为44.67%,经统计学处理,男女之间差异有统计学意义（P〈0.001）;细菌培养：108份女性阴道分泌物进行细菌培养,NG的检出率为16.64%,95份男性尿道分泌物进行细菌培养,NG的检出率为22.85%;直接涂片Gram染色：80份男性尿道分泌物进行Gram染色,NG的检出率为21.49%,78份女性阴道分泌物,NG的检出率为10.79%。3种检测方法经统计学处理,差异具有统计学意义（P〈0.01）。结论：PCR检测法特异性强,灵敏度高,可作为慢性淋病检测的首选方法。细菌培养检出率次之,直接涂片Gram染色的检出率最低。直接涂片Gram染色的检出率虽较低,但特异性高,在基层医院无PCR设备及细菌培养条件者可首选,是一种经济实用、简便易行的检测方法。     

Predictors of chlamydial infection and gonorrhea among patients seen by private practitioners.

OBJECTIVE: To identify the predictors of chlamydial infection and gonorrhea among patients tested by general practitioners. DESIGN: Prospective study. SETTING: General private practice, family planning and abortion clinic, adolescent clinic, sexually transmitted disease (STD) clinic and community health clinic in downtown Montreal. PATIENTS: The 2856 patients were included because of symptoms compatible with an STD, a history of sexual contact with a person known or suspected to have chlamydial infection, a history of a nonexclusive sexual relationship or presentation for an abortion. MEASURES: Patient information was obtained by the attending physician on a standard form. Enzyme immunoassay (EIA) for Chlamydia trachomatis and culture for Neisseria gonorrhoeae were performed on cervical (female) or urethral (male) samples. Stepwise logistic regression was used to identify the predictors of infection. RESULTS: The EIA results were positive in 11.1% of the cases and the culture results in 2.3%. Among the males chlamydial infection was independently associated with low age (odds ratio [OR] = 0.88 per year), heterosexuality (OR = 4.99), urethral discharge (OR = 3.74) and the absence of a history of gonorrhea (OR = 0.51). Gonorrhea was associated with urethral discharge (OR = 24.3) and homosexuality (OR = 3.68). Among the females chlamydial infection was associated with low age (OR = 0.79 per year), a history of sexual contact with a person known to have chlamydial infection (OR = 2.30), multiple sexual partners in the previous 12 months (OR = 1.60) and a reason for the test other than screening purposes (OR = 0.60). Gonorrhea was associated with a reason other than screening (OR = 0.24) and low age (OR = 0.74 per year). Among the patients tested for screening purposes age was the only significant predictor of chlamydial infection (OR = 0.79 per year), and the prevalence of gonorrhea was 0.4%. The actual rate of chlamydial infection was 11.8% among the patients younger than 25 years, 5.7% among those 25 to 34 years and 0.6% among those over 34. CONCLUSIONS: Age alone can be used as a criterion to screen for chlamydial infection among asymptomatic patients without a history of sexual contact with a person known or suspected to have such infection and with a history of a nonexclusive relationship. The prevalence in our population justifies screening people up to 34 years of age.     

FQ-PCR和ELISA法检测生殖器疱疹病毒抗原检测结果比较

本文对FQ-PCR和ELISA法检测生殖器疱疹病毒抗原的检测结果进行比较,为临床诊断治疗提供参考。分析邢台市第三医院皮肤性病科2015~2017年诊治的生殖器疱疹60例患者临床资料。采用酶联免疫吸附测定法(ELISA法)和荧光定量PCR法(FQ-PCR)检测样本中单纯疱疹病毒,检测结果不一致的样本采用单纯疱疹病毒通用引物分析。结果显示60例样本中FQ-PCR法检测阳性为46例,占76.7%,ELISA法检测阳性为48例,占80.0%,检测结果不一致样本为6例,占10.0%;1例FQ-PCR法阳性而ELISA法阴性样本经第二次检测后为阴性,3例ELISA法检测阳性而FQ-PCR法检测阴性样本经第二次检测后阳性为2例,阴性为1例;FQ-PCR法的敏感性、特异性、阳性预测值和阴性预测值分别为92.4%、96.3%、93.7%和94.5%,而ELISA法的上述指标分别为94.4%、96.3%、93.8%和95.8%。因此,ELISA法检测生殖器疱疹病毒抗原敏感性和特异性高,值得临床推广。     

女性生殖道沙眼衣原体感染分析

作者采用单克隆萤光抗体染色法检测５１６例妇科门诊患者宫颈沙眼衣原体（ＣＴ）感染状况，阳性者７０例，阳性率１３．６％；且发现ＣＴ感染随着年龄的增长而下降。ＣＴ感染的特征有阴道分泌物增多呈粘液及脓性、搔痒，腹痛及不孕等。ＣＴ沿宫颈管粘膜上行感染引起输卵管粘膜的损伤可能是引起不孕，异位妊娠的主要原因。选用可同时抗多种病原体的复合药灭菌灵阴道栓对６６例ＣＴ感染阳性的患者进行局部用药及配偶治疗；疗效满意。早期诊断及治疗可预防ＣＴ上行性感染，降低女性盆腔炎性疾病的发生。     

胎儿纤连蛋白（fFN）联合超声宫颈检查预测早产的临床价值

目的：探讨阴道分泌物胎儿纤维连接蛋白（fFN）检测联合阴道超声宫颈检查对早产预测的临床价值。方法选择收治的131例有先兆早产症状的孕妇,通过分别单独检测fFN、超声检查宫颈和联合2种方式,随访其妊娠结局,比较各种方式预测早产的临床价值。结果 fFN阳性组分娩率显著高于fFN阴性组,阴道超声检查宫颈阳性组分娩率显著高于宫颈检查阴性组,2组阳性组、阴性组比较差异具有统计学意义（P<0.05）;两者联合7 d内及14 d内预测早产分娩的敏感性、特异性、阳性预测率、阴性预测率分别为100.0%、83.6%、71.2%、100.0%,及100.0%、88.9%、82.8%、100.0%。结论分别检测fFN及阴道超声检查宫颈均对预测早产有意义,fFN呈阴性的临床预测价值更高。fFN检测联合超声宫颈检查预测7～14d内早产准确度、敏感度高达100.0%,是预测早产发生的敏感可靠指标,具有显著的临床价值。     

超声凝胶阴道填充后MRI在早期宫颈癌分期中的价值研究

  目的   探讨超声凝胶阴道填充后MRI在早期宫颈癌分期中的价值。   方法   前瞻性纳入经宫颈活检确诊为宫颈癌行MRI检查的患者158例,先行常规MRI检查,超声凝胶填充阴道后再行一次MRI检查。两名医师采用双盲法对凝胶填充前后宫颈癌MRI分期进行判定,以术后病理为金标准,比较同一患者前后2次检查对于鉴别Ⅱa期病例的阳性预测值、阴性预测值,及在判断宫颈癌Ⅱa期中的敏感度、特异度及准确度。   结果   两名医师采用双盲法对常规MRI图像进行分期,得到的一致性中等（κ=0.680）;而运用超声凝胶填充后对MRI图像进行分期时,结果一致性高（κ=0.932）。常规MRI 检查图像在鉴别宫颈癌Ⅱa期中的阳性预测值为66.67%,阴性预测值为76.74%;灵敏度、特异度及准确度分别为70.59%、73.33%和72.15%;超声凝胶填充阴道后MRI检查图像的阳性预测值为90.91%,阴性预测值为91.30%;灵敏度、特异度及准确度分别为88.24%、93.33%和91.14%,两者对比灵敏度、特异度及准确度差异有统计学意义（P<0.05）。   结论   超声凝胶阴道填充后行MRI检查在鉴别宫颈癌Ⅱa期中具有更高的诊断价值,其方法简便易行,可运用于宫颈癌的常规MRI检查中。     

经阴道三维超声在宫腔粘连诊断中的临床意义探讨

目的：对比经腹、阴道二维三维超声诊断宫腔粘连(intrauterine adhesions,IUA)效用,总结诊断价值。方法方便选取以2014年2月-2016年7月医院临床疑似IUA的的女性作为研究对象,入选对象176例,进行经腹、阴道二维三维超声诊断,最终采用宫腔镜诊断确诊,描述统计影像学特征,对比经腹、阴道超声诊断效用指标。结果经阴道三维超声敏感度、特异度、阳性预测值、阴性预测值、符合率分别为80.60%、88.10%、95.58%、58.73%、82.39%,经阴道二维超声、经阴道三维超声敏感度、特异度阳性预测值、阴性预测值、符合率高于经腹超声,经阴道三维超声特异度、阴性预测值、符合率高于经阴二维超声,差异具有统计学意义(P<0.05);三维超声误漏诊31例,其中漏诊26例。结论经阴道三维超声诊断宫腔粘连诊断效用高,但也可能会因子宫显示不全等原因出现误漏诊。     

性病门诊女性生殖器溃疡性疾病病因分析

目的了解性病门诊中,女性患者以生殖器溃疡为主要表现的疾病的病因。方法根据病史、临床表现,结合暗视野显微镜检查、梅毒血清学试验,PCR检测HSV-DNA等进行诊断。结果96例女性生殖器溃疡性疾病患者中,梅毒22例,占22.9%;生殖器疱疹30例,占31.3%;梅毒和生殖器疱疹混合感染2例,占2.1%;疑诊软下疳2例,占2.1%;白塞氏综合症5例,占5.2%;急性女阴溃疡6例,占6.3%;29例未能明确诊断,占30.2%。结论女性生殖器溃疡性疾病患者中,病因以生殖器疱疹、梅毒占多,软下疳少见。     

TO STUDY INCIDENCE OF CHLAMYDIAL GENITAL TRACT INFECTIONS USING ENZYME IMMUNO ASSAY-ANTIGEN DETECTION AND CELL CULTURE METHODS

Endocervical swabs from 315 patients were screened for chlamydial infection by using Enzyme Immuno Assay technique for antigen detection. Of these, 190 patients were of infertility and 125 patients were with history suggestive of pelvic inflammatory disease (PID). 100 age matched controls were also screened for the detection of chlamydial antigen by using EIA. The overall incidence of chlamydial infection in this study group was 15.2%. 21 (11.05%) of the infertility patients and 27 (21.6%) of the pelvic inflammatory disease cases were found to be positive for chlamydial antigen. The prevalence rate was found to be high in the age group of 31–40 years in both study groups i.e. infertility group (14.7%) and PID group (50%). All the ELISA positive cases (48) and randomly selected (10) age matched controls were screened by tissue culture using McCoy cell line. In the tissue culture, 44 of the 48 samples were found to be positive and none of the controls groups were found positive. 4 samples showed discordant results possibly due to the presence of non-viable organism or inhibitory material present at the sample site. The sensitivity and specificity of ELISA with respect to tissue culture are 100% and 71% respectively. The positive predictive value and the negative predictive value of the ELISA are 91.6% and 100% respectively. The efficiency of the test was found to be 93.1%.Key Words: Chlamydia trachomatis, Infertility, PID     

检测消化性溃疡HpSAg的临床意义

目的探讨幽门螺杆菌可溶性抗原(HpSAg)在诊断消化性溃疡幽门螺杆菌(Hp)感染中的临床价值。方法采用生物素-亲和素酶联免疫法测定186例消化性溃疡病人血清Hp可溶性抗原,判断病人Hp感染,并与快速尿素酶试验和美蓝染色检查结果比较。结果血清Hp可溶性抗原(HpSAg)检测诊断Hp灵敏度为91.35%,特异度为86.59%,阳性预测值为89.62%,阴性预测值为88.75%,阳性似然比为6.81,阴性似然比为0.10。结论HpSAg检测具有检测快速、经济、准确、便于大规模普查等优点,结果稳定、特异性高,可用于消化性溃疡Hp感染的临床诊断,治疗疗效观察和随访复查。     

HSVⅡ-DNA在生殖器疱疹检测中的应用

目的探讨HSVⅡ-DNA检测对生殖器疱疹中Ⅱ型单纯疱疹病毒（HSVⅡ）阳性检出率的应用价值。方法选取本院2010年7月～2012年7月性病门诊收治的生殖器疱疹患者135例为实验标本,分别予以荧光定量聚合酶链反应法（FQ-PCR）检测HSVⅡ-DNA和血清酶联免疫吸附法（ELISA）检测HSVⅡ抗体,再以病毒培养法评价以上两种方法的检出率。结果FO-PCR法HSVⅡ-DNA检测的HSVⅡ阳性检出率为74．1％,ELISA法HSVⅡ抗体检测的HSVⅡ阳性检出率为65．2％,作病毒培养标准检测的HSVⅡ阳性率为80．7％;FQ-PCR法检测HSVⅡ的灵敏度、阳性及阴性预测值、特异性显著高于ELISA法。结论FQ-PCR法HSVU-DNA检测的HSVⅡ阳性检出率更贴近于金标准值．并且检测上具有特异性强、灵敏度高、快速等优越性,对于临床诊断生殖器疱疹具有重要的应用价值,值得推广应用。     

阴道分泌物胎儿纤维连接蛋白与宫颈长度联合预测早产的多中心前瞻性研究

目的探讨阴道分泌物胎儿纤维连接蛋白（fFN）与宫颈长度测量联合应用在早产预测中的价值。方法选择2012年1月～2012年12月就诊的孕22～35周,有不规律宫缩,或有早产高危因素的121例孕妇为研究对象,检测其宫颈阴道分泌物中fFN,同时B超测量宫颈长度,比较其临产的时间及孕周情况。结果同时行宫颈长度超声测量与fFN检测的121例先兆早产孕妇中,82例孕妇的宫颈长度≤3．0cm,其中57例fFN呈阳性．25例呈阴性;39例宫颈长度〉3．0cm的孕妇中,4例fFN呈阳性,35例呈阴性。fFN阳性对7d内分娩预测的敏感度为75．44％,特异度为100．00％,阴性预测值为100．00％。宫颈缩短（≤3cm）者7d内分娩的敏感度、特异度、阴性预测值分别为52．44％、100．00％、100．00％;二者联合7、14d内分娩预测敏感度明显高于fFN检测和宫颈长度测量（P〈0．05）。结论阴道分泌物fFN比宫颈长度对预测7d及14d内分娩有较高的阴性预测值及特异度。超声宫颈长度测量联合可进一步提高其阳性预测值和特异度,提高对早产的预测。     

胎盘α1-微球蛋白的检测在诊断胎膜早破的价值

目的探讨阴道液中α1-微球蛋白（PAMG-1）定性检测诊断胎膜早破的价值。方法分析62例胎膜早破病例和38例胎膜未破病例的阴道液中PAMG-1、pH和HCG检测结果。结果PAMG-1检测胎膜早破的灵敏度、特异性和准确性分别为98．39％、100％和99．00％，阳性预测值为100％，阴性预测值为97，44％，灵敏度、准确度和阴性预测值明显高于pH和HCG方法，差异有显著性（P〈0．01）。结论少量阴道液PAMG-1检测对胎膜早破的诊断优于pH和HCG，且同样具有简单、快速、无创伤、实用的优点。     

Correlation of cervical cytology with cervical histology

OBJECTIVE: To correlate cervical cytology with Cervical histology. METHODOLOGY: A hospital based prospective study was carried out in consecutive total forty-three patient attending oncology clinic of Kathmandu Medical College Teaching Hospital, Sinamangal, Nepal from 1st Bhadra 2061 to end of Falgun 2061 (18th August 2004-12th February 2005) during authors posting in this clinic. All patients who underwent cervical biopsy on either indication of clinically suspected lesions or abnormal cytology were correlated with Pap smear report. Pap smear was carried out in conventional technique using Ayre's spatula. Cervical biopsy was carried out with help of punch biopsy forceps in operation Theatre without the guidance of colposcopy. All pertinent information regarding patient profile in terms of their age, parity, age at marriage, age at 1st child birth, smoking habit, contraceptive use, and symptom of vaginal discharge was taken. Reports of Pap smear and cervical biopsy of these patients were collected from oncology clinic during their follow up visit and all these information and finding were entered in structured questionnaire. The reporting of Pap smear was done in Bethesda system. The average duration between performing Pap smear and biopsy was of one month. Statistical analysis was carried out by EPI-INFOS6 system. RESULT: Of forty three patients who underwent cervical cytology 22 cases were of Benign lesion, 8 cases of LSIL, 9 cases of HSIL, 3 cases of invasive carcinoma and 1 of ASCUS. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and p-value in benign grade was 76%, 83.3%, 86.4%, 71.4%, 79.1%, 0.0004 respectively. Similarly sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and p-value in LSIL was 60%, 93.9%, 75%, 88.6%, 86%,0 .0008 respectively. For HSIL it was 100%, 89.5%, 55.6%, 100%, 90.7 0.0001 respectively. Respectively for carcinoma it was 100% for sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy p-value was 0.00008. CONCLUSION: Pap smear significantly correlated with cervical histology.