Skip to main content
NCBI home page
Sexually Transmitted Infections logoLink to Sexually Transmitted Infections
. 2004 Oct;80(5):401–405. doi: 10.1136/sti.2003.009134

Vaginal leucocyte counts in women with bacterial vaginosis: relation to vaginal and cervical infections

W Geisler 1, S Yu 1, M Venglarik 1, J Schwebke 1
PMCID: PMC1744893  PMID: 15459411

Abstract

Objectives: To evaluate whether an elevated vaginal leucocyte count in women with bacterial vaginosis (BV) predicts the presence of vaginal or cervical infections, and to assess the relation of vaginal WBC counts to clinical manifestations.

Methods: We retrospectively analysed the relation of vaginal leucocyte counts to vaginal and cervical infections and to clinical manifestations in non-pregnant women diagnosed with BV at an STD clinic visit.

Results: Of 296 women with BV studied, the median age was 24 years and 81% were African-American. Elevated vaginal leucocyte counts were associated with objective signs of vaginitis and cervicitis and also predicted candidiasis (OR 7.9, 95% CI 2.2 to 28.9), chlamydia (OR 3.1, 95% CI 1.4 to 6.7), gonorrhoea (OR 2.7, 95% CI 1.3 to 5.4), or trichomoniasis (OR 3.4, 95% CI 1.6 to 7.3). In general, as a screening test for vaginal or cervical infections, vaginal leucocyte count had moderate sensitivities and specificities, low positive predictive values, and high negative predictive values.

Conclusions: An elevated vaginal leucocyte count in women with BV was a strong predictor of vaginal or cervical infections. Vaginal leucocyte quantification may provide an alternative approach to assessing need for empirical therapy for chlamydia and gonorrhoea, particularly in resource-limited high STD risk settings that provide syndromic management.

Full Text

The Full Text of this article is available as a PDF (70.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Amsel R., Totten P. A., Spiegel C. A., Chen K. C., Eschenbach D., Holmes K. K. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. 1983 Jan;74(1):14–22. doi: 10.1016/0002-9343(83)91112-9. [DOI] [PubMed] [Google Scholar]
  2. Caldwell Harlan D., Wood Heidi, Crane Debbie, Bailey Robin, Jones Robert B., Mabey David, Maclean Ian, Mohammed Zeena, Peeling Rosanna, Roshick Christine. Polymorphisms in Chlamydia trachomatis tryptophan synthase genes differentiate between genital and ocular isolates. J Clin Invest. 2003 Jun;111(11):1757–1769. doi: 10.1172/JCI17993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Eschenbach D. A., Hillier S., Critchlow C., Stevens C., DeRouen T., Holmes K. K. Diagnosis and clinical manifestations of bacterial vaginosis. Am J Obstet Gynecol. 1988 Apr;158(4):819–828. doi: 10.1016/0002-9378(88)90078-6. [DOI] [PubMed] [Google Scholar]
  4. Hakakha Michele M., Davis Jane, Korst Lisa M., Silverman Neil S. Leukorrhea and bacterial vaginosis as in-office predictors of cervical infection in high-risk women. Obstet Gynecol. 2002 Oct;100(4):808–812. doi: 10.1016/s0029-7844(02)02147-6. [DOI] [PubMed] [Google Scholar]
  5. Lawing L. F., Hedges S. R., Schwebke J. R. Detection of trichomonosis in vaginal and urine specimens from women by culture and PCR. J Clin Microbiol. 2000 Oct;38(10):3585–3588. doi: 10.1128/jcm.38.10.3585-3588.2000. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Mattsby-Baltzer I., Platz-Christensen J. J., Hosseini N., Rosén P. IL-1beta, IL-6, TNFalpha, fetal fibronectin, and endotoxin in the lower genital tract of pregnant women with bacterial vaginosis. Acta Obstet Gynecol Scand. 1998 Aug;77(7):701–706. [PubMed] [Google Scholar]
  7. Moore S. G., Miller W. C., Hoffman I. F., Fox K. K., Owen-O'Dowd J., McPherson J. T., Privette A., Schmitz J. L., Leone P. A. Clinical utility of measuring white blood cells on vaginal wet mount and endocervical gram stain for the prediction of chlamydial and gonococcal infections. Sex Transm Dis. 2000 Oct;27(9):530–538. doi: 10.1097/00007435-200010000-00006. [DOI] [PubMed] [Google Scholar]
  8. Parks K. S., Dixon P. B., Richey C. M., Hook E. W., 3rd Spontaneous clearance of Chlamydia trachomatis infection in untreated patients. Sex Transm Dis. 1997 Apr;24(4):229–235. doi: 10.1097/00007435-199704000-00008. [DOI] [PubMed] [Google Scholar]
  9. Pate M. S., Hedges S. R., Sibley D. A., Russell M. W., Hook E. W., 3rd, Mestecky J. Urethral cytokine and immune responses in Chlamydia trachomatis-infected males. Infect Immun. 2001 Nov;69(11):7178–7181. doi: 10.1128/IAI.69.11.7178-7181.2001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Peipert J. F., Boardman L., Hogan J. W., Sung J., Mayer K. H. Laboratory evaluation of acute upper genital tract infection. Obstet Gynecol. 1996 May;87(5 Pt 1):730–736. doi: 10.1016/0029-7844(96)00040-3. [DOI] [PubMed] [Google Scholar]
  11. Peipert J. F., Montagno A. B., Cooper A. S., Sung C. J. Bacterial vaginosis as a risk factor for upper genital tract infection. Am J Obstet Gynecol. 1997 Nov;177(5):1184–1187. doi: 10.1016/s0002-9378(97)70038-3. [DOI] [PubMed] [Google Scholar]
  12. Peipert J. F., Ness R. B., Soper D. E., Bass D. Association of lower genital tract inflammation with objective evidence of endometritis. Infect Dis Obstet Gynecol. 2000;8(2):83–87. doi: 10.1002/(SICI)1098-0997(2000)8:2<83::AID-IDOG4>3.0.CO;2-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Platz-Christensen J. J., Mattsby-Baltzer I., Thomsen P., Wiqvist N. Endotoxin and interleukin-1 alpha in the cervical mucus and vaginal fluid of pregnant women with bacterial vaginosis. Am J Obstet Gynecol. 1993 Nov;169(5):1161–1166. doi: 10.1016/0002-9378(93)90274-m. [DOI] [PubMed] [Google Scholar]
  14. Ryan C. A., Courtois B. N., Hawes S. E., Stevens C. E., Eschenbach D. A., Holmes K. K. Risk assessment, symptoms, and signs as predictors of vulvovaginal and cervical infections in an urban US STD clinic: implications for use of STD algorithms. Sex Transm Infect. 1998 Jun;74 (Suppl 1):S59–S76. [PubMed] [Google Scholar]
  15. Schwebke Jane R., Weiss Heidi L. Interrelationships of bacterial vaginosis and cervical inflammation. Sex Transm Dis. 2002 Jan;29(1):59–64. doi: 10.1097/00007435-200201000-00010. [DOI] [PubMed] [Google Scholar]
  16. Sellors J., Howard M., Pickard L., Jang D., Mahony J., Chernesky M. Chlamydial cervicitis: testing the practice guidelines for presumptive diagnosis. CMAJ. 1998 Jan 13;158(1):41–46. [PMC free article] [PubMed] [Google Scholar]
  17. Smeltzer M. P., Curran J. W., Brown S. T., Pass J. Accuracy of presumptive criteria for culture diagnosis of Neisseria gonorrhoeae in low-prevalence populations of women. J Clin Microbiol. 1980 May;11(5):485–487. doi: 10.1128/jcm.11.5.485-487.1980. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Steinhandler Lauren, Peipert Jeffrey F., Heber Walter, Montagno Andrea, Cruickshank Courtney. Combination of bacterial vaginosis and leukorrhea as a predictor of cervical chlamydial or gonococcal infection. Obstet Gynecol. 2002 Apr;99(4):603–607. doi: 10.1016/s0029-7844(01)01788-4. [DOI] [PubMed] [Google Scholar]
  19. Sturm-Ramirez K., Gaye-Diallo A., Eisen G., Mboup S., Kanki P. J. High levels of tumor necrosis factor-alpha and interleukin-1beta in bacterial vaginosis may increase susceptibility to human immunodeficiency virus. J Infect Dis. 2000 Jul 18;182(2):467–473. doi: 10.1086/315713. [DOI] [PubMed] [Google Scholar]
  20. Thejls H., Rahm V. A., Rosen G., Gnarpe H. Correlation between chlamydia infection and clinical evaluation, vaginal wet smear, and cervical swab test in female adolescents. Am J Obstet Gynecol. 1987 Oct;157(4 Pt 1):974–976. doi: 10.1016/s0002-9378(87)80098-4. [DOI] [PubMed] [Google Scholar]
  21. Wiesenfeld Harold C., Hillier Sharon L., Krohn Marijane A., Landers Daniel V., Sweet Richard L. Bacterial vaginosis is a strong predictor of Neisseria gonorrhoeae and Chlamydia trachomatis infection. Clin Infect Dis. 2003 Feb 7;36(5):663–668. doi: 10.1086/367658. [DOI] [PubMed] [Google Scholar]
  22. Yudin Mark H., Hillier Sharon L., Wiesenfeld Harold C., Krohn Marijane A., Amortegui Antonio A., Sweet Richard L. Vaginal polymorphonuclear leukocytes and bacterial vaginosis as markers for histologic endometritis among women without symptoms of pelvic inflammatory disease. Am J Obstet Gynecol. 2003 Feb;188(2):318–323. doi: 10.1067/mob.2003.105. [DOI] [PubMed] [Google Scholar]

Articles from Sexually Transmitted Infections are provided here courtesy of BMJ Publishing Group

RESOURCES