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Combination of Bacterial Vaginosis and Leukorrhea as a Predictor of Cervical Chlamydial or Gonococcal Infection

From the Department of Obstetrics and Gynecology and the George Anderson Outcomes Measurement Unit, Women and Infants Hospital, Providence, Rhode Island.

Address reprint requests to: Jeffrey F. Peipert, MD, MPH, Women and Infants Hospital, Department of Obstetrics and Gynecology, 101 Dudley Street, Providence, RI 02905; E-mail: jpeipert{at}wihri.org.

OBJECTIVE: To evaluate whether the combination of bacterial vaginosis and leukorrhea on microscopic evaluation of a saline wet preparation is associated with cervical infection with Chlamydia trachomatis (C. trachomatis) or Neisseria gonorrhea (N. gonorrhea).

METHODS: A cross-sectional study of 598 patients was performed. Nonpregnant patients undergoing a saline wet preparation and microbiologic testing for C. trachomatis and N. gonorrhea were eligible. Providers prospectively collected data from saline microscopic analysis. Bacterial vaginosis was documented based on Amsel’s criteria, and ligase chain reaction testing of the endocervix was performed for C. trachomatis and N. gonorrhea.

RESULTS: On univariate analysis, young age (less than 25 years), unmarried marital status, black race, and the presence of leukorrhea were all associated with increased rates of testing positive for C. trachomatis and N. gonorrhea (P < .05). We stratified patients into three groups: 1) no evidence of bacterial vaginosis or leukorrhea; 2) evidence of either bacterial vaginosis or leukorrhea, but not both; and 3) evidence of both bacterial vaginosis and leukorrhea. Using logistic regression analysis to control for age, marital status, and race, we found an odds ratio of 3.8 (95% confidence interval 1.3, 11.6) for a positive microbiologic test for either C. trachomatis or N. gonorrhea in women with the combination of bacterial vaginosis and leukorrhea.

CONCLUSION: In this group of high-risk women seen in an urgent care facility, the presence of both bacterial vaginosis and leukorrhea was associated with an increased risk of cervical infection. Future prospective studies should evaluate whether empiric treatment of high-risk women with these findings is justified and cost-effective.

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