Investigations
1st investigations to order
pregnancy test
Test
A urinary or blood pregnancy test should be performed in all sexually active women, even if using a method of contraception.
Blood pregnancy test: beta-hCG blood level <5 mIU/mL indicates negative result.
Result
positive or negative
wet mount examination of cervical discharge
Test
Sensitive indicator of cervical inflammation, in the absence of inflammatory vaginitis.[9]
Microscopy is only 50% sensitive for detection of Trichomonas vaginalis; although culture is more sensitive than microscopy, it is less sensitive than nucleic acid amplification tests, which are now considered the gold standard test.[1][20]
Bacterial vaginosis may be diagnosed by presence of at least three of the four Amsel criteria: 1) adherent white vaginal discharge; 2) clue cells on microscopy (vaginal epithelial cells with distinctive stippled appearance as covered by bacteria); 3) vaginal pH >4.5; 4) 'whiff test' (release of fishy odour following addition of 10% potassium hydroxide solution).[22]
Result
>10 WBCs per high-power field of vaginal fluid (leukorrhoea), trichomonads, clue cells, pH >4.5, fishy amine odour with application of 10% potassium hydroxide
nucleic acid amplification testing (NAAT)
Test
Urine, vaginal swab (self-obtained), cervical swab, or combined with cervical cytology screening. Cervical specimens have the greatest sensitivity, but urinary and some vaginal swabs also have comparable predictive power. Rectal swabs may not be approved by regulatory agencies for use with NAAT.[9]
For Chlamydia trachomatis, Neisseria gonorrhoeae, or Mycoplasma genitalium, the sensitivity and specificity of urine specimens are 93.8% and 100%, respectively, compared with >99% for both parameters from endocervical specimens.[24] For Trichomonas vaginalis, the sensitivity and specificity of vaginal or endocervical swabs and urine samples is 88% to 100% and 95% to 100%, respectively.[20]
Result
positive for Chlamydia trachomatis or Neisseria gonorrhoeae or Mycoplasma genitalium orTrichomonas vaginalis
rapid tests (OSOM Trichomonas, AFFIRM VPIII)
Test
Fast and reliable point of care tests with sensitivity >83%, specificity >97%. Results available within 30 minutes for OSOM Trichomonas rapid test and in 45 minutes for AFFIRM VP III.
Result
positive for Trichomonas vaginalis
Thayer-Martin agar cervical culture
Test
For detection of N gonorrhoeae.
Result
growth of pathogen
Gram stain of cervical discharge
Test
For diagnosis of bacterial vaginosis. Nugent score is used, which involves counting bacterial morphocytes.[21]
Result
Lactobacillus morphotype reduced or absent
Investigations to consider
cervical cytology
Test
Not recommended as part of the screening protocol for women at risk of STIs. Routine screening protocols for cervical cytology should be followed.
Inflammatory changes are associated with chlamydial or gonorrhoeal infections but are not specific or sensitive enough for empirical therapy.[1]
Result
inflammatory changes
herpes simplex virus (HSV) serology
Test
Increased sensitivity for detection of HSV type 2 compared with culture if no active lesions or presentation of a recurrent infection.[1]
Result
presence of antibodies to HSV type 2
HIV serology
Test
Not a cause for cervicitis, but testing should be offered if any other sexually transmitted infection is diagnosed.
Result
negative
hepatitis B and C serologies
Test
Not a cause for cervicitis, but testing should be offered if any other sexually transmitted infection is diagnosed.
Result
negative
rapid plasma reagin testing
Test
Syphilis is not a cause for cervicitis, but testing should be offered if any other sexually transmitted infection is diagnosed.
Result
negative
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