Pediatric Cervicitis Workup
- Author: Latha Chandran, MBBS, MD, MPH; Chief Editor: Andrea L Zuckerman, MD more...
Laboratory Studies
Traditional tests
Wet mount of the discharge usually demonstrates more than 5 WBCs per high-power field. Most practice guidelines recommend a threshold of 10-30 polymorphonuclear (PMN) leukocytes per high-power field to support the diagnosis of mucopurulent cervicitis. However, leukocyte criterion is not standardized, and inflammation alone is not considered presumptive evidence of chlamydial infection.
Gram stains of the cervical mucopus may reveal gram-negative intracellular diplococci in cases of gonorrhea. Culturing in modified Thayer-Martin medium is the criterion standard for confirming gonorrhea.
Enzyme-linked immunosorbent assay or direct fluorescent antibody testing is often used to detect chlamydial infection. DNA probes with 90-97% sensitivity are also available for the simultaneous detection of gonococcal and chlamydial organisms.
When indicated, chlamydial cultures are performed on McCoy cells (evaluations in prepubertal children in whom sexual abuse is suspected, testing response to therapy in a previously treated infection).
Newer tests
Several highly specific and sensitive tests have been developed. These nucleic acid amplification tests (NAATs) include the polymerase chain reaction (PCR), the ligase chain reaction (LCR),[5] and transcription-mediated amplification (TMA). Probes used in these tests are at least 20% more sensitive than the earlier DNA probes and are the tests of choice.
PCR and LCR testing consists of amplification of specific DNA sequences, while TMA testing is an RNA amplification assay.
Although endocervical specimens are preferred, these tests may be easily performed on first-void morning urine samples as well as on vaginal and cervical samples. Urine NAATs are highly sensitive for the diagnosis of endocervical chlamydial infection.
Other Tests
Because of the possible association between bacterial vaginosis and mucopurulent cervicitis, perform NAATs and look for Amsel criteria for the diagnosis of bacterial vaginosis
Three of the following 4 criteria suffices for the diagnosis of bacterial vaginosis:
- Homogenous vaginal discharge
- Vaginal fluid pH greater than 4.5
- Clue cells greater than 20% of total vaginal epithelial cells on 100X magnification
- Amine odor on addition of potassium hydroxide to vaginal fluid
Marrazzo JM. Mucopurulent cervicitis: no longer ignored, but still misunderstood. Infect Dis Clin North Am. Jun 2005;19(2):333-49, viii. [Medline].
Darville T. Chlamydia. Pediatr Rev. Mar 1998;19(3):85-91. [Medline].
Darville T. Gonorrhea. Pediatr Rev. Apr 1999;20(4):125-8. [Medline].
Simpson T, Oh MK. Urethritis and cervicitis in adolescents. Adolesc Med Clin. Jun 2004;15(2):253-71. [Medline].
Smith KR, Ching S, Lee H, et al. Evaluation of ligase chain reaction for use with urine for identification of Neisseria gonorrhoeae in females attending a sexually transmitted disease clinic. J Clin Microbiol. Feb 1995;33(2):455-7. [Medline].
[Guideline] Workowski KA, Berman S,. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. Dec 17 2010;59(RR-12):1-110. [Medline].
Sexually transmitted diseases: gonorrhea, Chlamydia trachomatis, pelvic inflammatory disease and syphilis. In: Emans SJ, Laufer MR, Goldstein DP, et al, eds. Pediatric and Adolescent Gynecology. 4th ed. Philadelphia, PA: Lippincott-Raven; 1998:457-504.
Rome ES. Sexually transmitted diseases: testing and treating. Adolesc Med. Jun 1999;10(2):231-41, vi. [Medline].
Stuart GS, Castano PM. Sexually transmitted infections and contraceptives: selective issues. Obstet Gynecol Clin North Am. 30(4):795-808. [Medline].
Print
