Young, high-risk women; Women with BV: most mucopurulent cervicitis not tied to gonorrhea, chlamydia.(Gynecology)

PLAYA HERRADURA, COSTA RICA -- Among women with bacterial vaginosis, most mucopurulent cervicitis is not associated with gonorrhea or chlamydia infection, results of a study of young women in high-risk settings suggest.

Mucopurulent cervicitis (MPC), an inflammation of the cervical epithelium and stroma, is widely believed to result from infection with a sexually acquired organism such as Chlamydia trachomatis or Neisseria gonorrhoeae. Other causes are suspected, however, because laboratory studies using highly sensitive tests are often unable to detect either organism in some women with MPC, Dr. Jeanne Marrazzo said at a conference on vaginitis sponsored by Imedex.

Other researchers have reported an association between bacterial vaginosis (BV) and MPC that is independent of other sexually transmitted infections. For example, one study showed that women with BV who were treated with metronidazole also had improvement in MPC (Sex. Transm. Dis. 29[1]:59-64; 2002).

Dr. Marrazzo presented preliminary data from a prospective trial including 423 adolescent girls and women with BV who were assessed for cervicitis, defined as the presence of endocervical mucopurulent discharge or moderate to severe, easily-induced bleeding. The women were recruited from STD clinics in Pittsburgh and Seattle. Participants were aged from 14 to 45 years.

All patients had severe BV, defined by clinical Amsel criteria and a Nugent's score of at least 4. "These were 'hard-core' bacterial vaginosis women," said Dr. Marrazzo of the division of allergy and infectious diseases at the University of Washington, Seattle.

A total of 15% of the women had clinically obvious MPC, a rate that is consistent with many STD health care settings. An unexpected finding, however, was that the 63 women with MPC were significantly more likely to be older. "Over 30 you were more likely to have MPC, with an odds ratio of 6.6. We didn't expect that," she said.

"Increasing age may reflect some intrinsic immune or infectious issue," Dr. Marrazzo said. She speculated that older patients may have prolonged exposure to abnormal vaginal flora and/or other ...