A prospective study of genital infections in a family-planning clinic. 1. Microbiological findings and their association with vaginal symptoms

Abstract

A prospective study of genital infection was conducted in four inner-city family-planning clinics. Fifteen per cent of routine attenders had symptoms and signs of vaginal infection and many more women attended primarily because of symptoms. Among the women with both signs and symptoms, 70% had positive laboratory findings, Trichomonas vaginalis, Candida albicans and bacterial vaginosis being equally prevalent. Measurement of vaginal pH in the clinic was the single most useful clinical finding for directing empirical therapy. Among patients with a discharge confirmed on examination and an abnormally high pH, 72% had either T. vaginalis or bacterial vaginosis. Neisseria gonorrhoeae was isolated from 4% of women with, and 1% of those without, symptoms. We believe that it is worthwhile to investigate patients presenting to family-planning clinics with vaginal symptoms. No single specimen was found ideal for all pathogens, a cervical swab is better for gonococci and also for T. vaginalis but a vaginal swab is needed for candida and bacterial vaginosis.

PIP: 495 clients of 4 Manchester Family Planning Clinics, consulting for gynecological symptoms (194) or contraception (269), were examined to determine the prevalence of STD organisms and to rate signs, symptoms and laboratory findings for decisions about future screening. 38% of the family planning patients has symptoms of genital infection when asked. The 2 patients groups were combined, and signs and symptoms as well as laboratory results separated to establish criteria for lab screening. Among women with both signs and symptoms, 70% has positive laboratory findings. Trichomonas vaginalis, Candida albicans and bacterial vaginosis occurred in 22-26% of women with vaginal discharge. 72% of women with vaginal pH 4.5 has trichomonas and/or clue cells compared with 15% of those with normal pH. Cervicitis or cervical contact bleeding was associated with trichomonas. Candida, but not clue cells, was linked with vaginal inflammation. N. gonorrhoea was isolated from 12 women (2.4%), 10 of whom has symptoms. These results suggest that women with high pH could be given metronidazole before laboratory confirmation; that bacterial infection can be diagnosed by vaginal discharge, high pH and clue cells; that cervical swabs are more accurate than vaginal swabs for determining trichomonas; and that cervical smears for cytology are equally good for trichomonas; and that the high prevalence of gonococci justifies use of a culture medium that will also support growth of Candida.