title: Cervical infections in emergency department patients with vaginal bleeding.
abstract: To the best of the authors' knowledge, no previous study has compared the prevalences of Chlamydia trachomatis (CT) or Neisseria gonorrhoeae (NG) cervical infection among pregnant and non-pregnant patients presenting to the emergency department (ED) with vaginal bleeding.
  
  
  OBJECTIVE
  To determine the prevalence of these infections in a simultaneously assembled cohort, and to determine whether pregnancy is associated with altered rates of CT or NG cervical infection among patients with vaginal bleeding.
  
  
  METHODS
  This was a prospective, seven-month, cross-sectional study of a convenience sample of patients (aged > or = 15 years) who presented to an urban, teaching ED with the chief complaint of vaginal bleeding. A urine pregnancy test was administered to each patient. Cervical swab specimens were analyzed for CT or NG via polymerase chain reaction technology (DNA probe). The hospital laboratory's baseline 18% rate of positive tests was used for sample size planning. Chisquare analysis and Fisher's exact test, where appropriate, were used to compare pregnant and non-pregnant patient groups.
  
  
  RESULTS
  Cervical infection rates did not differ between pregnant and non-pregnant patients. Testing for CT showed that 13 of 114 (11%) of the pregnant patients were positive, while 11 of 147 (8%) non-pregnant patients tested positive (chi(2) = 0.759, p = 0.384). Testing for NG revealed that seven of 114 (6%) pregnant patients tested positive, while 16 of 147 (11%) non-pregnant patients tested positive (chi(2) = 1.256, p = 0.262). Combined testing showed that 18 of 114 (16%) of the pregnant patients and 25 of 147 (17%) of the non-pregnant patients harbored a cervical infection with one or both pathogens (chi(2) = 0.009, p = 0.925).
  
  
  CONCLUSIONS
  The prevalence of CT or NG cervical infection in pregnant patients presenting to the ED with vaginal bleeding is 16%. Pregnant and non-pregnant patients with vaginal bleeding are at similar risks for having CT or NG cervical infection. Cervical swab specimens should be obtained in all patients with vaginal bleeding.
authors.affiliation: Department of Emergency Medicine, Truman Medical Center, UMKC School of Medicine, Kansas City, MO, USA. lhoffman@unmc.edu
authors.forename: Lance
authors.initials: L
authors.lastname: Hoffman
authors.forename: O John
authors.initials: OJ
authors.lastname: Ma
authors.forename: Gary
authors.initials: G
authors.lastname: Gaddis
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schwab
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology*; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000453:epidemiology*; D006470:Hemorrhage / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D014623:Vaginal Diseases / Q000453:epidemiology* / Q000382:microbiology