Purulent Vaginal Discharge Research Articles

VAGINAL ECTOPIC URETER WITH GARTNER'S DUCT CYST

In ureteral duplication anomalies a distal lower ectopic ureter usually will not require removal after heminephrectomy. We recently cared for a woman presenting with a purulent vaginal discharge. Retained secretions in an ectopic ureter draining into a Gartner’s duct cyst necessitated distal ureterectomy. The Gartner’s duct cyst was left in place in the vagina. CASE REPORT A 24-year-old woman presented with recurrent urinary tract infections and persistent purulent vaginal discharge. Evaluation of incontinence at age 5 years had revealed a duplicated collecting system on the right side, and right upper pole heminephrectomy was performed. The location of the upper pole ureteral orifice was never identified. At age 19 years further evaluation for the same symptoms revealed a ureteral orifice adjacent to the urethral meatus at the introitus. Left upper pole heminephrectomy was performed with resolution of incontinence. Excretory urography was performed for the recurrent symptoms and confirmed the bilateral heminephrectomies. Cystoscopy revealed normally placed ureteral orifices in the bladder. The left ectopic ureteral orifice could not be seen at the introitus or in the urethra. On vaginal examination a purulent discharge was seen coming from the area of a right Gartner’s duct cyst (fig. 1). Abdominal computerized tomography revealed a tubular, fluid filled structure running adjacent to the right ureter (fig. 2). Distal ureterectomy through a suprapubic approach was performed without removal of the vaginal component. The patient remains well 6 months following distal ureterectomy. The Gartner’s duct cyst remains palpable but no further treatment has been necessary. duplicated collecting system on the left side with an ectopic FIG, 1, speculum examination reveals Gartner,s duct cyst (large lateral to cervix DISCUSSION Embryologically, the ureteral bud arises from the mesonephric duct, separates from its origin and inserts into the urogenital sinus.’ The distal remnant of the mesonephric duct becomes the Gartner’s duct, which runs from the hymen to the uterine adnexae along the lateral vaginal wall. Failure of the ureteral bud to separate from the mesonephric duct leads to ureteral termination in the Gartner’s duct or Gartner’s duct cyst. Vaginoscopy or speculum examination may reveal the Gartner’s duct cyst lateral to the cervuf as Seen in this patient. While the urological literature descnbes ectopic ureteral entry into a Gartner’s duct cyst, documented case reports are rare due to the infrequency with which the distal ureter needs to be removed.z.3 Whether the Gartner’s duct cyst itself needs to be removed and with what morbidity are not well delineated in the urological literature. we elected not to remove the cyst to avoid entering the vawa but we would perform marsupialization of the cyst If the Patient were to become symptomatic.

Postpartum mummification of a co-twin fetus in a Cameroon dwarf goat doe

An 18-month-old Cameroon dwarf goat doe had chronic, bilateral hindlimb paresis and difficulty in rising two months after the birth of a normal kid. The doe was weak, pyrexic and...

Bacteremia caused by nonhemolytic group B streptococci

Case Report A 75-yr-old woman with a history of type 2 noninsulin-dependent diabetes and hepatic cirrhosis with previous acute episodes of encephalopathy was admitted to the hospital because of abdominal swelling, tenderness of several day’s duration, and nausea On physical examination, the patient was afebrile and had tender hepatomegaly, ascites, and jaundice with normal central nervous system findings. The white blood cell count was 8,100/mm3 (85% neutrophils, 12% lymphocytes, and 3% monocytes). Prythrocyte sedimentation rate was 102 mm at the first hour. Other hematologic studies, metabolic profile, and liver function tests showed increased serum amylase (2,832 U/L), hyperglycemia, and hyperbilirubinemia An ultrasonogmphic study was done and a clinical diagnosis of acute pancreatitis was confiied. Medical therapy was begun, and the disease was self-limited within 3 d after treatment was instituted On the fifth day after admission, the patient underwent gynecological exploration because of vaginal discomfort, and a sample of the purulent vaginal discharge was sent to microbiology laboratory for culture. On the sixth day, she suddenly developed fever (39”C), and three sets of blood cultures were obtained. Empiric treatment with cefotaxime (2 g tid i.v.) was begun, yet the patient remained febrile. The vaginal sample grew a pure culture of a gram-positive, nonhemolytic coccus subsequently identified as Sneptoc0ccus agalactiue (3). The same microorganism also grew in all three blood culture sets after overnight incubation (BacTAlert system, Organon Teknika). A Gram stain of the blood culture showed gram-positive cocci resembling streptococci. The organism grew on sheep blood agar at 37°C with 5% COZ as small, white, slightly convex, nonhemolytic colonies, and hemolysis was not detectable on lifting a colony from the agar. The isolate was catalase-negative, PYRand bile esculin-negative, bacitracin-resistant, and did not grow in the presence of 6.5% sodium chloride. In addition, positive reactions for voges-Proskauer and hippurate hydrolysis tests were obtained. Group B streptococcal antigen was demonstrated with the PhadeBact test system (Karo Bio Diagnostics, Sweden), and a biochemical profile consistent with group B streptococci was obtained with the API 20 Strep test (bioM&ieux, France). Serotyping of the isolate by agglutination with antisera to GBS serotypes I through V (Dako A/S, Denmark) produced agglutination with the type II antisera. Repeated subcultures of the isolate onto blood agar under aerobic and anaerobic conditions failed to produce beta hemolysis. No pigment production was seen when the isolate was cultured in Granada medium, a selective and differential pigmentenhancing culture medium (4).

Streptococcus agalactiae: a vaginal pathogen?

The significance of Streptococcus agalactiae as an aetiological agent in vaginitis was evaluated. A total of 6226 samples from women who presented with vaginal symptoms was examined. The presence of >10 leucocytes/high-power field (h.p.f.) was taken to be the criterion of active infection. S. agalactiae was isolated from 10.1% of these samples. The isolation rates of other common pathogens such as Candida spp., Gardnerella vaginalis and Trichomonas spp. were 54.1%, 27.2% and 4.2%, respectively, in the same group of patients. In contrast, the isolation rates of these micro-organisms in the group of patients who had no infection (<10 leucocytes/h.p.f.) were 4.2%, 38.3%, 33% and 0.5%, respectively. In the majority of samples from which S. agalactiae was isolated, it was the sole pathogen isolated (83%) and its presence was associated with an inflammatory response in 80% of patients. Furthermore, the relative risk of vaginal infection with S. agalactiae (2.38) in patients with purulent vaginal discharge was greater than that of Candida spp. infection (1.41) and lower than that of Trichomonas spp. infection (8.32). These data suggest that S. agalactiae in symptomatic women with microscopic evidence of inflammation should be considered a causative agent of vaginitis.

Desquamative inflammatory vaginitis: A new subgroup of purulent vaginitis responsive to topical 2% clindamycin therapy

Desquamative inflammatory vaginitis is an uncommon clinical syndrome of unknown cause characterized by diffuse exudative vaginitis, epithelial cell exfoliation, and a profuse purulent vaginal discharge. The purpose of this report is to describe 51 patients with desquamative inflammatory vaginitis, the majority of whom were treated with 2% topical clindamycin in an open observational study. A retrospective chart review found 51 patients seen in a referral university vaginitis clinic between 1987 and 1993 who met the case definition of desquamative inflammatory vaginitis. All patients had diffuse exudative purulent vaginitis, signs of epithelial cell exfoliation (increased parabasal cells), elevated vaginal pH, and Gram stain findings of complete or relative absence of the normal long gram-positive bacilli and their replacement by gram-positive cocci. No consistent microbiologic pathogen was identified except for the absence of lactobacilli and an overall increase in prevalence of group B streptococci. Intravaginal treatment with 2% clindamycin suppositories resulted in clinical improvement in > 95% of patients and, although relapse occurred in 30%, overall antimicrobial cure was accomplished in all patients. Postmenopausal patients with desquamative inflammatory vaginitis occasionally required supplementary estrogen therapy to maintain remission. Desquamative inflammatory vaginitis responsive to topical clindamycin 2% therapy represents an uncommon cause of purulent vaginitis with unique clinical and laboratory characteristics. Evidence suggests a microbial, possibly gram-positive coccal, cause for this syndrome, although a specific bacterial species responsible for all cases has not been identified. The majority of cases occurred in patients in whom estrogen deficiency may have played a role in pathogenesis.

Vaginal flora and pelvic inflammatory disease

Forty-one patients with acute pelvic inflammatory disease were evaluated for the coexistence of bacterial vaginosis. Because all patients had a copious purulent vaginal discharge, microscopic criteria could not be used and microbiologic criteria were employed. The vaginal bacterial flora were not consistent with that of bacterial vaginosis, because Lactobacillus and other gram-positive bacteria dominated with colony counts of 10(3) to 10(5) cfu/ml (colony-forming units per milliliter). Endocervical specimens yielded Neisseria gonorrhoeae from 20 patients and Chlamydia trachomatis from 11 patients. Anaerobes were not dominant in any site sampled. A total of 147 bacteria were isolated from the endometrium, 16 (11%) of which were anaerobes. Thus the endogenous bacterial flora were not consistent with that of the microbiologic definition of bacterial vaginosis. N. gonorrhoeae was the most common isolate from the endocervix and endometrium; it was isolated three times more frequently from the endocervix and two times more frequently from the endometrium than was C. trachomatis.

Endometritis in cattle experimentally induced by Chlamydia psittaci.

On the day of estrus, eight virgin heifers received intrauterine inoculations of yolk sac propagated Chlamydia psittaci strain BovEnd 11/88 isolated from the uterus of a slaughter cow. All heifers developed purulent vaginal discharge which persisted for 3 to 7 weeks. Chlamydiae or chlamydial antigen were detected in vaginal and uterine discharges of infected animals by culture or Capture ELISA, while other bacterial pathogens were not found. In sera of the chlamydia-infected heifers marked increases in antibody titres against the chlamydial genus-specific LPS-antigen were found by ELISA and complement fixation test. Six heifers were artificially inseminated in 5 successive cycles beginning at the first estrus following intrauterine inoculation. In two of the infected heifers spontaneous healing of endometritis occurred after 5 estrus cycles. Only these animals conceived after the 5th breeding, whereas in the remaining four animals a chlamydia-associated chronic endometritis was recognized as the cause of infertility in the 19th and 26th week p.i. at slaughter. Two control heifers which remained clinically normal after intrauterine exposure to sterile yolk sac-suspensions conceived at the 1st and 2nd service, respectively.

Equine reproduction (1993)

The objectives of this observational study were to assess the ability of automated activity monitoring (AAM) to detect estrus for first insemination, the accuracy of detection, and the optimum interval from the estrus alert from the AAM system to insemination. Four commercial farms using 1 of 2 commercial AAM systems were studied over 1 yr. Cows were inseminated between 55 and 80 d in milk (DIM) based on AAM only, then by a combination of AAM and timed artificial insemination (AI). Blood progesterone was measured in 1,014 cows at wk 5, 7, and 9 postpartum; purulent vaginal discharge (PVD) was assessed at wk 5; and lameness and BCS at wk 7. Overall, AAM detected 83% of cows in estrus by 80 DIM. Cows that had 3 serum progesterone <1 ng/mL, had PVD, or were both lame and had BCS ≤2.5 has lesser odds of being detected in estrus by 80 DIM (62, 68, and 53%, respectively). Blood samples were collected on the day of 445 AI based on AAM and 323 timed AI. The proportion of cows not in estrus (progesterone >1 ng/mL) on the day of AI was similar between AAM (4 ± 1.8%) and timed AI (3 ± 1.2%). Managers elected, based on subjective criteria, not to inseminate 17% of cows for which an AAM estrus alert was issued, of which 43% were not in estrus. Activity data were extracted from AAM software for 1,399 AI. Onset of estrus was calculated using the same or similar data processing criteria as the AAM system. Producers recorded the time of AI. The interval from onset of estrus to AI was categorized as 0 to 8, 8 to 16, or 16 to 24 h. We found no effect of AAM system on the probability of pregnancy per AI, but noted an interaction of interval with parity. For multiparous cows, the probability of pregnancy per AI was 31%, which did not differ with the interval to AI. For primiparous cows, the odds of pregnancy were greater if AI occurred 0 to 8 h (49%) than 8 to 16 (36%) or 16 to 24 h (31%) after the estrus alert from the AAM. Automated activity monitoring can detect estrus for first AI in just over the length of 1 estrous cycle for over 80% of cows, but the remainder would likely require intervention for timely insemination. For multiparous cows, performing AI based on AAM once per day would not affect pregnancy per AI, but for primiparous cows AI within 8 h of the onset of estrus may be advantageous.

Diagnostic judgments of nurse practitioners providing primary gynecologic care

To determine the accuracy of experienced nurse practitioners' judgments of the probability of chlamydial infection of the cervix, to identify the clinical factors ("cues") related to the judgments, and to discern likely sources of judgment error. Cross-sectional study with prospective data collection. Urban hospital-based clinic. 492 nonpregnant women receiving primary gynecologic care. Four nurse practitioners recorded clinical data, tested women for chlamydial infection, and judged the probability of chlamydial infection using six categories: less than 1%, 1-4%, 5-9%, 10-24%, 25-50%, and greater than 50%. Chlamydial infection was detected by immunofluorescent assay in 31 (6%) of the 492 women. Although the median probability judgment was 5-9%, judgments were only weakly related (p = 0.08) to actual rates of infection. In a multivariate analysis, eight clinical cues were independently (p less than 0.05) related to nurse practitioners' probability judgments: age less than 20 years; past chlamydial or gonococcal infection; new sex partner; partner with suspected genital infection; genito-urinary symptoms; cervicitis, purulent vaginal discharge; and malodorous vaginal discharge. A linear model based on the eight cues, weighted according to their regression coefficients, predicted chlamydial infection more accurately than did the nurse practitioners' actual judgments (ROC curve areas 0.69 vs. 0.58, respectively; p less than 0.05). However, only two of the eight cues (age less than 20 years and purulent vaginal discharge) were actually related to chlamydial infection in a second multivariate model; this model bad accuracy similar to that of an empirically derived prediction rule (ROC curve areas 0.77 and 0.80, p = 0.27). Nurse practitioners were often inaccurate in their diagnostic judgments. Our analyses suggest that this inaccuracy stemmed from both the inconsistent use of clinical cues and the use of cues that were not related to chlamydial infection. Therefore, interventions such as algorithms that promote consistency and accuracy in diagnostic use of relevant cues would be likely to improve their diagnostic judgments.

Testing for cervical Chlamydia trachomatis infection in an inner city practice.

The aims of the study were to find the prevalence of cervical Chlamydia trachomatis infection in women attending for a speculum examination, to examine possible risk factors, and to see if we could develop a rational policy for testing for chlamydia in our deprived inner London practice. During 18 months 409 women aged 17-45 (mean 28) who attended for a cervical smear or vaginal examination were tested for chlamydia using the direct immunofluorescent test. They were assessed for possible risk factors: age less than 25, more than one sexual partner in the previous 3 months, sexual contact with men with urethritis, past history of chlamydia infection, purulent vaginal discharge, cervicitis and abnormal cervical cytology. Thirty-six women (8.8%) were chlamydia positive. Chlamydia infection was significantly associated with the presence of purulent vaginal discharge or an inflammatory cervical smear. In view of the prevalence of chlamydial cervicitis, the lack of symptoms and signs, and the potential consequences of untreated infection, ideally all young women in this population should be offered screening when they attend for a speculum examination. If this is not practical, chlamydia testing might be offered to women thought to be in high-risk groups including those with purulent vaginal discharge or an inflammatory cervical smear.

Characterization of 2 Groups of Actinomyces‐like Bacteria Isolated from Purulent Lesions in Pigs

Two groups of Actinomyces-like bacteria isolated from purulent lesions in pigs, were characterized and compared with Actinomyces pyogenes of porcine origin. One group showed characteristics which differed in many respects from A. pyogenes but which corresponded more closely to those of the non-official species 'Actinomyces suis'. Certain carbohydrate reactions differed from those given in earlier descriptions. This group was isolated only from purulent vaginal discharge and aborted foeti. The other group resembled the 'A. suis'-like bacteria but differed in its colony morphology, hippurate and to some extent also in its cellobiose and gluconate reactions and in its habitat. It was concluded that 'A. suis' may occur in lesions other than mammary actinomycosis in areas where this disease is extremely rare, and that its natural habitat is the genital tract of pigs. Furthermore a probably related group exists, which is found in purulent lesions located mainly outside the porcine genital tract. These organisms appear to be as frequent in these types of lesions as A. pyogenes, with whom they can easily be confused in routine diagnostic bacteriology.

A new diagnostic index for predicting cervical infection with eitherChlamydia trachomatis orNeisseria gonorrhoeae

To develop and test a diagnostic index for estimating the probability of cervical infection with either Chlamydia trachomatis or Neisseria gonorrhoeae. Prospective, cross-sectional study in two phases: 1) to develop a diagnostic index based on independent predictors of cervical infection; 2) to test the index. A hospital-based clinic and a student health service. Development phase: 190 nonpregnant women seen in the gynecology clinic; testing phase: 588 women seen in the gynecology clinic (n = 372) or the student health service (n = 216). Experienced clinicians recorded historical, physical, and microscopic findings on standard forms and tested women for chlamydial and gonococcal infections. Three independent predictors of cervical infection were identified and weighted: age (two points if less than 20 years and one point if 20-29 years); a new sex partner or one suspected of having a genital infection (one point); purulent vaginal discharge (one point). In the testing groups, cervical infection was present in none of 62 women with no points, seven of 269 (3%) with one point, 14 of 188 (7%) with two points, and 19 of 69 (28%) with three or four points (p less than 0.001). The index estimated the probability of infection more accurately (p less than 0.01) than did clinicians, performed well in each site, and remained accurate when C. trachomatis and N. gonorrhoeae were considered separately. The diagnostic index accurately estimates the probability of cervical infection with either C. trachomatis or N. gonorrhoeae and may be useful in selecting women for definitive diagnostic testing.

Characteristics of Trichomonas vaginalis Isolates from Women with and without Colpitis Macularis

Colpitis macularis, the most specific clinical sign for diagnosis of trichomoniasis, was detected by colposcopy in 52 of 118 infected women. Patients with colpitis macularis had a mean (+/- SD) of 18 +/- 20 Trichomonas vaginalis organisms/field (x 400 magnification) compared with 7 +/- 17 in patients with colpitis macularis (P less than .003). To compare possible virulence markers in isolates from women with and without colpitis macularis, isolates were analyzed for hemolytic activity, abscess production in an animal model, and adherence to cells in tissue culture. The mean hemolytic activity (relative to complete hemolysis) was 84% for 22 isolates from women with and 78% for 29 isolates from women without colpitis macularis. After subcutaneous injections in mice, abscesses were produced by 70% of isolates from patients with and 68% from patients without colpitis macularis. After a 15-min exposure, 39% of radiolabeled isolates from women with or without colpitis macularis adhered to HeLa cell monolayers. Purulent discharge, the second most useful sign for clinical diagnosis, was associated with colpitis macularis and with the number of organisms per high-power field on wet mount (P less than .01 for each comparison) but was not correlated with any experimental assay. Thus, no experimental characteristic of T. vaginalis isolates was associated with colpitis macularis or purulent vaginal discharge.

Utero vaginal malformations: A trap for the unsuspecting surgeon

Eighteen girls with major uterovaginal malformations were admitted to the Pediatric Surgical Service over a 17-year period. The diagnosis was not suspected or delayed in more than one half of the patients. The encountered anomalies were divided into four groups: I, isolated uterovaginal malformations (UVM) (4); II, UVM with anorectal anomalies (8); III, UVM with cloacal (urogenital sinus) abnormalities (5); and IV, caudal twinning (1). Imperforate hymen, vaginal web, low vaginal obstruction, or disorders of gonadal or chromosomal development were excluded. Patients presented with an abdominal mass or distension (5), abdominal pain (4), "sciatic"-like pain (1), purulent vaginal discharge with perineal pain (1), amenorrhea (2), and a pelvic and prerectal mass (1). The introitus was reported as normal in 11 patients with vaginal atresia or agenesis by the primary physician. Diagnostic studies, in addition to clinical and endoscopic examination, included routine radiological workup, genitourinary contrast studies, pelvic and perineal sonography, computerized tomography (CT) scanning, and more recently, magnetic resonance imaging. In complicated UVM, especially vaginal duplications with unilateral atresia, the CT scan was the most helpful diagnostic tool. Laparotomy was necessary, not only for therapeutic, but diagnostic reasons; even so, complex anomalies, such as vaginal duplication with unilateral atresia and a septate uterus, could not be suspected. Treatment was directed toward the restoration of a functional uterovaginal tract and the frequently associated anorectal anomalies. A review indicated that contrary to our expectations, the major UVM occurred in children with a low imperforate anus rather than the high variety.

Clinical manifestations of vaginal trichomoniasis.

Trichomonas vaginalis was detected by culture or wet-mount examination in 118 (15%) of 779 randomly selected women attending a sexually transmitted disease clinic. Vaginal trichomoniasis was significantly associated with symptoms of yellow discharge, abnormal vaginal odor, and vulvar itching and with signs of colpitis macularis ("strawberry cervix"), purulent vaginal discharge, and vaginal and vulvar erythema. A logistic regression model was used to adjust for coinfections, as well as for demographic, behavioral, and other possible confounding variables. Trichomonas vaginalis remained significantly associated with symptoms of yellow vaginal discharge (odds ratio [OR] = 2.4) and vulvar itching (OR = 3.0) and with signs of colpitis macularis (OR = 241), purulent vaginal discharge (OR = 8.0), vulvar erythema (OR = 2.5), and vaginal erythema (OR = 4.3). The sensitivity of symptoms and signs associated with trichomoniasis was relatively low. Nevertheless, clinical manifestations can be used to identify those patients for whom a wet-mount examination would likely have high yield. Careful clinical examination and selective use of wet-mount examination together with wider use of more sensitive tests for subclinical infection, such as culture or direct immunofluorescent staining of vaginal fluid, could lead to improved detection and control of this infection.

Clinical manifestations of vaginal trichomoniasis

<i>Trichomonas vaginalis</i>was detected by culture or wet-mount examination in 118 (15%) of 779 randomly selected women attending a sexually transmitted disease clinic. Vaginal trichomoniasis was significantly associated with symptoms of yellow discharge, abnormal vaginal odor, and vulvar itching and with signs of colpitis macularis ("strawberry cervix"), purulent vaginal discharge, and vaginal and vulvar erythema. A logistic regression model was used to adjust for coinfections, as well as for demographic, behavioral, and other possible confounding variables.<i>Trichomonas vaginalis</i>remained significantly associated with symptoms of yellow vaginal discharge (odds ratio [OR] = 2.4) and vulvar itching (OR = 3.0) and with signs of colpitis macularis (OR = 241), purulent vaginal discharge (OR = 8.0), vulvar erythema (OR = 2.5), and vaginal erythema (OR = 4.3). The sensitivity of symptoms and signs associated with trichomoniasis was relatively low. Nevertheless, clinical manifestations can be used to identify those patients for whom a wet-mount examination would likely have high yield. Careful clinical examination and selective use of wet-mount examination together with wider use of more sensitive tests for subclinical infection, such as culture or direct immunofluorescent staining of vaginal fluid, could lead to improved detection and control of this infection. (<i>JAMA</i>1989;261:571-576)

Isolation of Chlamydia trachomatis and Neisseria gonorrhoeae from the genital tract of sexually abused prepubertal females

Vaginal cultures for Chlamydia trachomatis were obtained from 195 prepubertal female children (2–12 years of age) evaluated for reported sexual abuse. The rate of positive cultures for C. trachomatis in this population was 2.6% (5/195). Neisseria gonorrhoeae was also recovered in 2.6% (5/195) of these patients. Concomitant infection with N. gonorrhoeae was found in one girl who was culture positive for C. trachomatis. Only 21 (11%) of the evaluated patients had a vaginal discharge, however, purulent vaginal discharge was noted in all children with positive vaginal cultures (9/9). The positive predictive value of vaginal discharge for these sexually transmitted diseases was 43% (9/21). C. trachomatis was isolated as often as N. gonorrhoeae in this population of prepubertal children. The data suggest that although these organisms are not often recovered from prepubertal girls being evaluated for sexual abuse, those with purulent vaginal discharge should be cultured for both C. trachomatis and N. gonorrhoeae.

Contraception in general practice analyzed by a computerized medical record.

By a computerized medical record 174 patients who consulted a general practitioner regularly for contraceptive advice through 51 months were selected. There were 67 patients aged 25.9 +/- 4.0 (mean +/- SD), using Lynestrenol 0.75 mg and etinyloestradiol 375 micrograms or Levonorgestrel 0.150 mg and etinyloestradiol 30 micrograms. Eleven patients aged 27.2 +/- 5.3 using Noretisteron 0.3 mg and 96 patients aged 33.3 +/- 6.0 using intrauterine contraceptive device (IUCD). As judged by the Pearl index, the Pill-users unwantedly and unexpectedly became pregnant more often than IUCD-users. Acute salpingitis was encountered in six Pill-users, and in one with IUCD. There was more often purulent vaginal discharge and metrorrhagia in the Pill-group, but the hemoglobin values were similar. The importance of these findings remain to be established, but they suggest that the IUCD may be more reliable than the Pill, perhaps due to a better compliance. Eight IUCD patients did not return for changing the device in due time after 36 months of use. Four out of 13 patients with cervical dysplasia did not return for prescribed controls of the cervical smear. The computerized medical record seems to be a powerful tool for the monitoring of high risk patients and clinical research in general practice.

Predicting acute pelvic inflammatory disease: A multivariate analysis

A multivariate logistic regression analysis of patient symptoms and signs and laboratory findings associated with the diagnosis of acute pelvic inflammatory disease was performed with use of data from 628 women who were clinically diagnosed as having the disease for the first time at the University of Lund, Sweden. In 414 women (65.9%) acute pelvic inflammatory disease was laparoscopically confirmed. We developed a mathematical model that correctly predicted 87.0% of the cases of acute pelvic inflammatory disease and had an overall correct classification rate of 75.6%. Variables that were good predictors of acute pelvic inflammatory disease were purulent vaginal discharge, erythrocyte sedimentation rate ≥15 mm/hr, positive gonorrhea result, adnexal swelling on bimanual examination, and rectal temperature ≥38°C. Furthermore, we developed “mixed model I” and “mixed model II,” which combine simple clinical parameters and laparoscopy in varying degrees. In mixed model I the sensitivity, specificity, and overall classification values were 93.%, 67.2%, and 84.5%; in mixed model II these values were 100%, 67.2%, and 89.2%. Use of relatively simple and reproducible clinical parameters can identify those women who would most benefit from laparoscopy to diagnose acute pelvic inflammatory disease.

Investigation of purulent vaginal discharge in cows, with particular reference to Haemophilus somnus.

The relationship between vaginal discharge, site of inflammation in the reproductive tract and species of bacteria isolated was examined in cows that were either normal, subfertile, or had had an abnormal parturition. Microbiological and cytological examinations were performed on uterine swabs from 221 cows and cervical swabs from 107 cows. There were 167 subferitle cows, 144 of which had failed to conceive to 3 or more services (FTC) and 23 of which had not had a visible oestrus since calving (NVO). Metritis was diagnosed in 22% of the FTC cows, 48% of the NVO cows, and 12% of the cows with abnormal parturition. Fifty percent of cows with metritis had purulent vaginal discharge. However, only 25% of a total of 91 cows with vaginal discharge had metritis; the remainder had cervicitis. Fifty-four percent of subfertile cows had cervicitis without metritis. Mixed infection with aerobes and anaerobes was significantly correlated with uterine inflammation and was found in 20% of cows with metritis. The rate of isolation of H.somnus from inflamed uteruses (22%) and inflamed cervixes (39%) was significantly greater than the isolation rate from normal uteruses (8%) and cervixes (10%). No bacteria were isolated from 50% of inflamed uteruses and 37% of inflamed cervixes. The number of subfertile cows with or without metritis that subsequently conceived was not significantly different.