Vaginal polymorphonuclear leukocytes and bacterial vaginosis as markers for histologic endometritis among women without symptoms of pelvic inflammatory disease

Objective: The study was performed to determine whether vaginal polymorphonuclear leukocytes can be used as predictors of histologic endometritis among women at risk for, but without symptoms of, acute pelvic inflammatory disease. Study design: Five hundred thirty-seven women with, or at risk for, p...

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Published in:American journal of obstetrics and gynecology 2003-02, Vol.188 (2), p.318-323
Main Authors: Yudin, Mark H., Hillier, Sharon L., Wiesenfeld, Harold C., Krohn, Marijane A., Amortegui, Antonio A., Sweet, Richard L.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Bacterial diseases
Bacterial diseases of the genital system
bacterial vaginosis
Biological and medical sciences
endometritis
Endometritis - complications
Female
Forecasting
Human bacterial diseases
Humans
Infectious diseases
Medical sciences
Neutrophils - pathology
pelvic inflammatory disease
Pelvic Inflammatory Disease - complications
Pelvic Inflammatory Disease - pathology
Predictive Value of Tests
predictors
Sensitivity and Specificity
Vagina - pathology
Vaginal polymorphonuclear leukocytes
Vaginosis, Bacterial - complications
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Summary:Objective: The study was performed to determine whether vaginal polymorphonuclear leukocytes can be used as predictors of histologic endometritis among women at risk for, but without symptoms of, acute pelvic inflammatory disease. Study design: Five hundred thirty-seven women with, or at risk for, pelvic infection underwent pelvic examinations, including endometrial biopsies. These women were assessed for the presence of vaginal polymorphonuclear leukocytes, bacterial vaginosis, sexually transmitted diseases, and histologic endometritis. Results: Vaginal neutrophils were present in 240 (44.7%) and histologic endometritis was present in 77 (14.3%) of the study population. Women with histologic endometritis were significantly more likely to have vaginal neutrophils present, with an odds ratio of 3.2 (95% CI 1.9-5.7). When study subjects were stratified by the presence of sexually transmitted diseases and vaginal neutrophils, the prevalence of histologic endometritis was highest in women with both conditions present, with an odds ratio of 7.0 (95% CI 3.5-14.3). When subjects were stratified by the presence of bacterial vaginosis and vaginal neutrophils, the prevalence of histologic endometritis was again highest in women with both conditions present, with an odds ratio of 4.8 (95% CI 1.4-16.3). The presence of vaginal neutrophils diagnosed by saline wet mount had a high sensitivity (90.9%) and negative predictive value (94.5%), but a low specificity (26.3%) and positive predictive value (17.1%) for the diagnosis of upper genital tract infection. Conclusion: The presence of vaginal polymorphonuclear leukocytes has a high sensitivity and negative predictive value for the diagnosis of upper genital tract infection. (Am J Obstet Gynecol 2003;188:318-23.)
ISSN:0002-9378
1097-6868
DOI:10.1067/mob.2003.105