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Microbiological Profile of the Cervix in 1,000 Sexually Active Women
Author(s) -
Kovacs G.T.,
Westcott M.,
Rusden J.,
Asche V.,
King H.,
Haynes S.E.,
Moore E.K.,
Hall B.E.
Publication year - 1988
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1988.tb01667.x
Subject(s) - medicine , vaginal discharge , gardnerella vaginalis , chlamydia , gynecology , mycoplasma hominis , gonorrhea , obstetrics , cervix , ureaplasma urealyticum , asymptomatic , chlamydia trachomatis , neisseria gonorrhoeae , metronidazole , mycoplasma , bacterial vaginosis , family medicine , immunology , antibiotics , microbiology and biotechnology , biology , cancer , human immunodeficiency virus (hiv)
EDITORIAL COMMENT: The take‐away message from this careful study is that of 1,000 women attending a family planning clinic, microbiological study isolated Mycoplasmas in more than 50%, Chlamydia in 5% and gonorrhoea in about 0.5%— although only 16% of the women presented because of pain, discharge or suspicion of sexually transmitted disease. In those patients with 2 or more sexual partners in the past year the incidence of mycoplasma infection was somewhat higher but the risk of chlamydial infection was doubled. In the 25% of women with symptoms, Gardnerella was cultured in 40% and Candida in only 20%. How does one apply this information to ordinary gynaecological or general practice? If a patient presents with vaginal itch and discharge, unless she has obvious clinical signs of Candida, she should be prescribed a course of a tetracycline (Chlamydia, Mycoplasmas, gonorrhoea) and metronidazole (Gardnerella, trichomonas). This is shotgun therapy but the only alternative is more sophisticated bacteriological investigation of outpatients — 2 cervical swabs for Chlamydia and a third in Amies transport medium for culture of Neisseria gonorrhoeae and the genital mycoplasmas, and for Gardnerella and other anaerobes. The final comment is that it is uncertain if any treatment is indicated when culture reveals Mycoplasmas or Gardnerella, especially if the patient is asymptomatic — it would be mindboggling if doctors should accept that almost 50% of asymptomatic women who attend for contraceptive advice harbour vaginal organisms that require treatment. Summary: One thousand consecutive women who attended the Richmond Family Planning Association Clinic and who were to undergo a vaginal examination were asked to participate in a large prospective microbiological study. Participants were questioned about their sexual activity during the previous 12 months and any apparent signs of sexually transmitted disease. On examination the cervix was inspected for evidence of inflammation, ectopy or discharge and cervical swabs were taken for microbiological assessment. Chlamydia trachomatis was isolated in 5.1 % of women tested while Ureaplasma urealyticum and Mycoplasma hominis were found in 48.8% and 16.4% of women respectively. Significant associations were found between the number of sexual partners during the previous 12 months and the incidence of all 3 organisms. The carriage rate of the genital mycoplasmas was significantly affected by the type of contraception. In addition the association between the presence of the genital mycoplasmas and pelvic and cervical abnormalities was determined.