Leukocytes and lactobacilli of vaginal discharge as a predictor of pelvic inflammatory disease

Shin, Jong Seung; Park, Cheol Hong; Yoo, E Hwa; Lee, Sang Gyu

Abstract

OBJECTIVE
We performed this study to evaluate whether the vaginal polymorphonuclear leukocytes and few lactobacilli on microscopic evaluation of a saline wet preparations would be associated with pelvic inflammatory disease (PID) in Korean women.
MATERIALS AND METHODS
We performed a cross-sectional study of 556 women between 16 and 78yrs of age from May 2001 to May 2003. Wet-mount microscopic examination of vaginal discharge was done on all patients. Positive vaginal polymorphonuclear leukocytes was defined as more than 10 white blood cells per high-power field on microscopic examination, and few lactobacilli was defined as less than 30 per high-power field on microscopic examination. The diagnosis of PID was relied on the minimal criteria delineated by the Centers for Disease Contral and Prevention, elevated CRP or ESR and positive anaerobic cultures.
RESULTS
On univariate analysis, positive vaginal polymorphonuclear leukocytes and few lactobacilli were associated with PID, but age (less than 25) and marital status were not. On multivariate analysis using multiple logistic regression, odds ratios of positive vaginal polymorphonuclear leukocytes and few lactobacilli for PID were 5.995 (95%CI: 3.056-11.761) and 24.39 (95%CI: 10.989-55.556) respectively. The sensitivity and negative predictive value of positive vaginal polymorphonuclear leukocytes or few bacilli for predicting PID were 90.6% and 94.42% respectively.
CONCLUSION
Positive vaginal polymorphonuclear leukocytes and few lactobacilli were strongly associated with PID. Positive vaginal polymorphonuclear leukocytes and few lactobacilli have a high sensitivity and negative predictive value for predicting PID. Therefore the existence of vaginal polymorphonuclear leukocytes and few lactobacilli are thought hereafter to be useful marker to diagnose PID.