AN EVALUATION OF THE CRITERIA OF DIAGNOSIS AND CURE OF GONORRHEA IN THE FEMALE

Abstract

Summary 1. This study involves over 6,100 smears and 3,200 cultures in the diagnosis of 598 cases of gonorrhea in the adult female, and the treatment of 431 of them. 2. A single smear missed 59 per cent and a single culture, 38 per cent of the infected cases, but three smears and three cultures missed only 0.2 per cent. As a criterion for cure, three smears and three cultures in the ten days after treatment missed 8 per cent of the treatment failures. 3. The culture proved 1.7 times as accurate as the smear for diagnosis but no more accurate than the smear for the detection of treatment failures. 4. False negative laboratory reports are due to (a) some biologic factor of which little is known, (b) the technique in taking specimens, and (c) laboratory errors. These, in the case of smears, are most commonly the result of in sufficient study of the slide, and in the case of cultures are due to the delicacy of the organism and its need for special handling. 5. False positive results may be socially disastrous. They are found rarely with a properly performed culture. 6. In vulvovaginitis, of which 97 putative cases were studied, the smear proved of little value because of the high percentage of false positive reports. Cultures, including sugar differentiation, should be the sole method of diagnosis. 7. In adult females both smears and cultures should be used, as the accuracy of diagnosis is increased significantly. The smear offers an opportunity for a rapid report if it is positive. The culture technique presents some difficulty for other than institutional practice, but it is feasible under most circumstances. 9. Stricter and more uniform criteria for the diagnosis and determination of cure of gonorrhea in the adult female should be established by professional agreement. The minimum proposed to rule out gonorrhea is three smears and cultures, and to determine a cure, a succession of smears and cultures over a period of two months.