Vaginal leukocyte counts for predicting sexually transmitted infections in the emergency department - 29/10/21
, Justin M. Elkins, MD b, Michael M. Mohseni, MD a, Jessica Monas, MD c, Santiago Cantillo Campos, MD b, Ronald B. Benard, MD b, Carolyn Mead-Harvey, MS d, Lanyu Mi, MS dAbstract |
Background |
The use of vaginal white blood cell (WBC) counts to predict sexually transmitted infections (STIs) in the emergency department (ED) is incompletely characterized.
Objectives |
Our objective was to assess the relationship between vaginal wet preparation WBC counts and STIs and to determine whether WBC counts of at least 11 WBCs per high-power field (HPF) could be useful for identifying STIs in women in the ED.
Methods |
Female ED patients 18 years or older who were evaluated in a single health system between April 18, 2014, and March 7, 2017, and had a genital wet preparation WBC result were retrospectively examined using univariable and multivariable analysis.
Results |
Vaginal wet preparation WBC counts were examined for 17,180 patient encounters. Vaginal WBC counts of at least 11 WBCs/HPF were associated with increased odds of having gonorrhea, chlamydia, or trichomoniasis. When this threshold was used for the diagnosis of each STI, sensitivity ranged from 48.2% to 53.9%, and specificity ranged from 67.2% to 68.8%.
Conclusion |
Women with STIs are more likely to have higher vaginal WBC counts. However, higher vaginal wet preparation WBC counts in isolation have limited diagnostic utility for gonorrhea, chlamydia, and trichomoniasis. Incorporation of age, urine leukocyte esterase results, and vaginal WBC counts provided a better predictor of an STI than vaginal WBC counts alone.
Le texte complet de cet article est disponible en PDF.Keywords : Chlamydia, Gonorrhea, Leucorrhea, Trichomoniasis, Vaginitis
Abbreviations : CDC, ED, HPF, ICD-9-CM, ICD-10-CM, IT, NAAT, SQL, STI, UTI, WBC
Plan
| ☆ | Portions of this manuscript have been published in the following: Elkins JM, Hamid OS, Simon LV, et al. Association of Bartholin cysts and abscesses and sexually transmitted infections. Am J Emerg Med. 2020 Apr 15 (Online ahead of print). doi:j.ajem.2020.04.027 Campos SC, Elkins JM, Sheele JM. Descriptive analysis of prostatitis in the emergency department. The American Journal of Emergency Medicine. 2021 Jun 1;44:143–7. Mohseni M, Simon LV, Sheele JM. Epidemiologic and Clinical Characteristics of Tubo-Ovarian Abscess, Hydrosalpinx, Pyosalpinx, and Oophoritis in Emergency Department Patients. Cureus. 2020 Nov;12(11). Elkins JM, Cantillo-Campos S, Sheele JM. Frequency of Coinfection on the Vaginal Wet Preparation in the Emergency Department. Cureus. 2020 Nov;12(11). Elkins JM, Cantillo-Campos S, Thompson C, Mohseni M, Sheele JM. Descriptive Evaluation of Male Emergency Department Patients in the United States With Gonorrhea and Chlamydia. Cureus. 2020 Oct;12(10). Mohseni MM, Benard RB, Mead-Harvey C, Mi L, Lindor RA, Sheele JM. Sexually transmitted infections in the emergency department are not associated with holidays or school breaks. The American Journal of Emergency Medicine. 2020 Nov 13. |
Vol 49
P. 373-377 - novembre 2021 Retour au numéro
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