We agree with the underlying conclusion of McCaw, that Chlamydia trachomatis and Neisseria gonorrhoeae infections should be considered in the differential diagnosis of women presenting with vaginal or urinary symptoms. However, we disagree with her discussion on the relative importance of these organisms with respect to our study results.We deliberately eliminated patients suspected of having cervicitis, urethritis/cystitis, or pelvic inflammatory disease by using the following exclusionary criteria: tenderness on bimanual examination, discharge from the cervical os, or evidence of pyuria on urine examination. Since neither Ctrachomatis nor N gonorrhoeae cause vaginitis, culturing these organisms in our study population would imply an asymptomatic infection of the cervix. Although the prevalence of asymptomatic C trachomatis in selected populations warrants screening cultures, their presence does not cause vaginal symptoms in the absence of cervicitis. Our study evaluated the role of symptoms and signs in the diagnosis of vaginal infections
Schaaf VM, Perez-Stable EJ. Testing for Chlamydial and Gonorrhea Infection in the Diagnosis of Vaginitis-Reply. Arch Intern Med. 1991;151(6):1227–1228. doi:10.1001/archinte.1991.00400060137026
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