title: Surrogate methods to diagnose gonococcal and chlamydial cervicitis: comparison of leukocyte esterase dipstick, endocervical gram stain, and culture.
abstract: This study compared leukocyte esterase dipsticks (LED) and endocervical Gram stains (EGS) as surrogates for culture diagnosis of gonococcal and chlamydial cervicitis in 495 STD clinic patients. Overall, gonorrhea prevalence was 15.7%; chlamydia prevalence (in the subgroup that was tested) was 17.8%. In diagnosing gonorrhea, LED and EGS performed similarly, with sensitivities of 68% and 76%, respectively, and identical specificities of 44%. In diagnosing gonococcal or chlamydial cervicitis, LED and EGS sensitivities fell to 48% and 47%, respectively, whereas specificities increased to 55% and 75%. These data suggest that, although both tests are imperfect surrogates for gonococcal and chlamydial culture, LED sacrifices little in sensitivity compared with EGS. Because LED does not require ancillary supplies, equipment, electricity, or trained personnel, its use may be feasible when Gram-stain diagnosis is impossible. Modifications of LED technology and specimen preparation should be sought to improve LED performance.
authors.affiliation: Calbot County Health Department, Easton, Maryland.
authors.forename: C R
authors.initials: CR
authors.lastname: Knud-Hansen
authors.forename: G A
authors.initials: GA
authors.lastname: Dallabetta
authors.forename: C
authors.initials: C
authors.lastname: Reichart
authors.forename: K M
authors.initials: KM
authors.lastname: Pabst
authors.forename: E W
authors.initials: EW
authors.lastname: Hook
authors.forename: J N
authors.initials: JN
authors.lastname: Wasserheit
mesh_terms: D002265:Carboxylic Ester Hydrolases; D002584:Cervix Uteri / Q000382:microbiology; D002690:Chlamydia Infections / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D005260:Female; D005840:Gentian Violet; D006069:Gonorrhea / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification*; D010619:Phenazines; D011237:Predictive Value of Tests; D015995:Prevalence; D013048:Specimen Handling; D013194:Staining and Labeling; D002575:Uterine Cervicitis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D014626:Vaginal Smears; D014627:Vaginitis / Q000150:complications / Q000382:microbiology
chemical_list: C035863:Gram's stain; D010619:Phenazines; C021443:leukocyte esterase; D002265:Carboxylic Ester Hydrolases; D005840:Gentian Violet