Vaginal polymorphonuclear leukocytes and bacterial vaginosis as markers for histologic endometritis among women without symptoms of pelvic inflammatory disease.
OBJECTIVE
The study was performed to determine whether vaginal polymorphonuclear leukocytes can be used as predictors of histologic endometritis among women at risk for, but without symptoms of, acute pelvic inflammatory disease.


METHODS
Five hundred thirty-seven women with, or at risk for, pelvic infection underwent pelvic examinations, including endometrial biopsies. These women were assessed for the presence of vaginal polymorphonuclear leukocytes, bacterial vaginosis, sexually transmitted diseases, and histologic endometritis.


RESULTS
Vaginal neutrophils were present in 240 (44.7%) and histologic endometritis was present in 77 (14.3%) of the study population. Women with histologic endometritis were significantly more likely to have vaginal neutrophils present, with an odds ratio of 3.2 (95% CI 1.9-5.7). When study subjects were stratified by the presence of sexually transmitted diseases and vaginal neutrophils, the prevalence of histologic endometritis was highest in women with both conditions present, with an odds ratio of 7.0 (95% CI 3.5-14.3). When subjects were stratified by the presence of bacterial vaginosis and vaginal neutrophils, the prevalence of histologic endometritis was again highest in women with both conditions present, with an odds ratio of 4.8 (95% CI 1.4-16.3). The presence of vaginal neutrophils diagnosed by saline wet mount had a high sensitivity (90.9%) and negative predictive value (94.5%), but a low specificity (26.3%) and positive predictive value (17.1%) for the diagnosis of upper genital tract infection.


CONCLUSIONS
The presence of vaginal polymorphonuclear leukocytes has a high sensitivity and negative predictive value for the diagnosis of upper genital tract infection.
Yudin
Mark H
MH
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital, Pennsylvania, USA.
Hillier
Sharon L
SL
Wiesenfeld
Harold C
HC
Krohn
Marijane A
MA
Amortegui
Antonio A
AA
Sweet
Richard L
RL
D000293:Adolescent; D000328:Adult; D004716:Endometritis / Q000150:complications*; D005260:Female; D005544:Forecasting; D006801:Humans; D009504:Neutrophils / Q000473:pathology*; D000292:Pelvic Inflammatory Disease / Q000150:complications* / Q000473:pathology*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014621:Vagina / Q000473:pathology*; D016585:Vaginosis, Bacterial / Q000150:complications*