To the Editor.—
The fact that Schaaf et al1 did not include testing for gonorrhea and chlamydial infection in their evaluation of patients who presented with vaginal symptoms significantly limits the usefulness of their findings. Women with symptoms of possible acute pelvic inflammatory disease were appropriately excluded from the study, but this does not eliminate the need to test for gonorrhea and chlamydial infection. Many women (often the majority) with these two infections have mild symptoms or no symptoms2; therefore, limiting investigation of vaginal/urethral symptoms to only Candida, Trichomonas, and bacterial vaginosis is an important oversight. This omission is particularly puzzling since in 1983 Schachter3 documented an overall prevalence of chlamydial infection in 9.8% (range, 5.5% to 22.5%) of women screened during routine visits to family-planning clinics in San Francisco, Calif, the clinic populations from which Schaaf's study was drawn. Schachter noted that 70% of these infections
McCaw B. Testing for Chlamydial and Gonorrhea Infection in the Diagnosis of Vaginitis. Arch Intern Med. 1991;151(6):1227. doi:10.1001/archinte.1991.00400060137025
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