Leukocyte esterase activity in the rapid detection of urinary tract and lower genital tract infections in obstetric patients

Abstract

Infections of the vagina and urinary tract are important problems for the obstetrician. Examination of the vaginal discharge and urine for the presence of leukocytes is an important part of the evaluation for vaginitis and urinary tract infections. Neutrophils contain several esterases that are not present in serum, urine, or vaginal secretions. These esterases are not influenced by bacteria, commonly used drugs, or variable compositions of urine or vaginal secretions. A prospective study was performed to assess the sensitivity and specificity of leukocyte esterase activity as measured by dipstick (Chemstrip 9, Biodynamics) for the prediction of vaginitis and urinary tract infections during pregnancy. Results were compared with those obtained from potassium hydroxide smears, wet preps, and urine cultures. The vaginal discharge and urine of 65 patients was tested for leukocyte esterase activity on their initial OB visit. Leukocyte esterase was 100% sensitive and 100% specific for detecting urinary tract infections. It was 100% sensitive and 90% specific for predicting vaginal infections. Trichomonas infections accounted for the positive leukocyte esterase results when the urine culture was negative. On the basis of this study we believe that leukocyte esterase activity is sufficiently sensitive and specific to permit use of this test as a rapid and inexpensive screening procedure for vaginitis and urinary tract infections.