Sellors J, Howard M, Pickard L, Jang D, Mahony J, Chernesky M
Department of Family Medicine, McMaster University, Hamilton, Ont.
CMAJ. 1998 Jan 13;158(1):41-6.
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.
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.
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.
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.
检验加拿大性传播疾病（STD）指南中的一项建议，即黏液脓性宫颈分泌物以及革兰氏染色宫颈涂片每个高倍视野有10个或更多多形核白细胞（PMN），或者在无法进行革兰氏染色时，宫颈分泌物的存在以及宫颈水肿、红斑或诱发性黏膜出血之一，可被视为衣原体宫颈炎的诊断依据。
共有596名连续前往两家计划生育诊所接受常规护理的女性接受了阴道窥器检查，并进行了沙眼衣原体和淋病奈瑟菌检测。记录革兰氏染色宫颈涂片的PMN计数以及衣原体感染假定指标的有无。
衣原体宫颈炎的患病率为6.2%（37/596），且无女性淋病奈瑟菌检测呈阳性。基于黏液脓性宫颈分泌物和每个高倍显微镜视野10个或更多PMN的指南标准对衣原体宫颈炎进行的推定诊断，敏感性和特异性分别为18.9%和97.0%，阳性预测值为29.2%，阳性似然比（LR）为6.2（p = 0.003）。基于宫颈分泌物伴有宫颈水肿、红斑或诱发性黏膜出血的推定诊断，敏感性和特异性分别为43.2%和80.0%，阳性预测值为12.5%，阳性LR为2.2（p = 0.002）。在存在细菌性阴道病或阴道炎的情况下，黏液脓性宫颈分泌物和每个高倍视野10个或更多PMN标准的LR为5.4（p = 0.04），而在不存在细菌性阴道病和阴道炎时，LR为4.
