97: Utility of Wet Prep In Predicting Cervical Infections In Women

Abstract

Patients presenting with gynecological complaints is common in the emergency department. However, diagnosing Chlamydia trachomatis (CT) and/or Neisseria gonorrhoeae (NG) cervical infections can be difficult in the emergency department without real time testing and history and physical is known to be notoriously unreliable. We evaluated the utility of the wet prep (present of either white cells or Trichomonas vaginalis (TV)) in diagnosing CT and/or NG. A retrospective chart review was performed at a single academic hospital. Patients between the age of 18 to 55 were included who had a chief complaint that would require a pelvic examination and had concurrent testing for gonorrhea and chlamydia via polymerase chain reaction technology (DNA probe). Wet prep mounts were analyzed by a trained technician in the lab and reported as white cells present (none, few, moderate, or many) and the presence of TV. 6 months of data were analyzed from December 2007 to May 2008. Chi-square analysis was used to compare presence of white cells and TV in predicting CT and/or GC. 1043 encounters were reviewed. A total of 158/1043 (15.1%) patient encounters were positive for CT and/or NG (CT: 98/158, 62%; GC: 35/158, 22%; CT+GC: 25, 16%). 1033 wet prep results were available for analysis. 117/1033 (11.3%) were positive for TV. For those positive with TV, 21/117 (18%) were positive for CT and/or GC. For those who did not have TV, 136/916 (14.8%) were positive for CT and/or GC (Chi-square = 0.55, p = 0.49). 257/1033 (24.9%) had moderate/many white cells present on the wet prep mount. For those with “moderate/many” white cells present on wet prep, 53/257 (20.6%) were positive for CT and/or GC. For those with “few/none” white cells present on wet prep, 104/776 (13.4%) were positive for CT and/or GC (Chi-square = 7.26, p = 0.007; OR = 1.68 [95% CI 1.16-2.42]). Patients who present with a gynecological complaint that are eventually diagnosed with CT and/or GC, TV is an unreliable marker for diagnosis. However, having moderate to many white cells present on wet prep may slightly increase the probability of CT and/or GC. Adjunct testing using wet prep is not reliable in helping make a diagnosis of CT and/or GC in the emergency department.