Clinical gonorrhoea in the female: laboratory findings

ABSTRACT

The practice of treating females with vaginal discharges and other pelvic symptoms, on the basis of a presumptive diagnosis of "Clinical gonorrhoea" without attempting to obtain adequate laboratory tests for N. Gonorrhoea, T. Vaginalis and C. Albican in female patients. All of whom had reported to a V. D. Clinic, (some because they were reported as contacts of male gonorrhoea patients), and who had been selected for penicillin treatment. All had vaginal discharges and other evidence of genital disease. The study was carried out at the Comphrensive Health Centre in Kingston, Jamaica. Tests for Gonorrhoea included cervical and vaginal gram-stained smears and cervical cultures. Due to shortages of media and personnel, cultures for the comparison of smear and cultures involved, for about half of the female studied, a single Transgrow bottle culture from the cervix and for the other half a Transgrow bottle culture and also a small (5.5cm) Thayer-Martin plate. Other patients had a rectal culture on a small Thayer-Martin plate also. These were included not alo in the comparison of results with overall tests for N. Gonorrhoea, E. Baginalis and C. Albicans. Transgrow cultures were incubated immediately. Tests for T. Vaginalis included wet preparations and cultures on "Trichomonas medium". Tests for C. Albicans involved cultures on Sabouraud's agar with yeast identified as C. Albicans by the germination test as described by Taschdjian and associates. A total of 107 or 45.9 percent of 233 females had positive tests for gonorrhoea. (In three of these the test were doubtful). 104 or 44.6 percent had positive tests for T. Vaginalis; 72 or 30.9 percent had positive tests for C. Albicans. Overall, 187 patients or 80.2 percent were positive (or doubtful) to one or more tests and 46 or 19.8 percent were negative to all three. Patients with mixed infections were N. gonorrhoea + T. Vaginalis - 15.4 percent, n. gonorrhoea + C. Albicans - 7.3 percent, N. gonorrhoea + C. Albicans T. Vaginalis - 6.4 percent, T. Vaginalis + C. Albicans - 5.6 percent. Of 92 or 41.8 percent of a total of 220 females studied, and who were positive or doubtful, only 40 or 18.2 percent of the total had positive or doubtful smears, while 52 or 23.6 percent of the total had only positive cultures. The latter would have been missed had smears alone been done. (i.e. 56.5 percent of cases). Of 94 or 44.3 percent of 212 females studied by T-M and Transgrow media, 76 had both tests positive. A total of 18 had one test positive, 7 with Transgrow and 11 with T-M. Of 104 patients who had both rectal and cervical cultures, 8 or 7.7 percent had only the rectal culture positive. There were 23 positive rectal cultures compared with 51 cervical positives out of a total of 59 with positive cultures. Of 140 patients with Trichomonal infestation, 107 had positive wet preparations while 114 had positive cultures. The advantage of culture over wet preparation is therefore but slight. It is clear that smears are inadeqate as anything more than supplementary diagnostic aids and that cultures for gonorrhoea are absolutely essential in the diagnosis of gonorrhoea in the female. Rectal cultures were found to add substantial increase (15.7 percent) to the number of positive cases when used in conjunction with cervical cultures. This must be clear to all physicians and cultures made available for their use(AU)