Science Selections August 2003

Objectives: The aim of this study was to establish the prevalence of cervicovaginal infections in normal third-trimester pregnant women and evaluate the accuracy of clinical diagnosis. diagnosis was based on the characteristics of the vaginal discharge, and the etiological diagnosis was based on bacterioscopy of the vaginal secretion and direct immunofluorescence for Chlamydia trachomatis. The data were analyzed statistically, determining the sensitivity, specificity, and positive and negative predictive value of the clinical diagnosis related to the laboratory diagnosis of the different infections. The accuracy of clinical diagnosis was low, with sensitivity between 50% and 65% and specificity around 60%, with the exception of trichomoniasis, which showed a sensitivity of 100% and chlamydia, with a sensitivity of 0% and a specificity of 100%. Conclusion: The accuracy of the clinical diagnosis of infections was low, specifically with respect to the positive predictive value. The results demonstrate the need for specific testing of cervicovagi-nal infections at prenatal visits. Reliance on simple vaginal examination results in a low yield for detection of vaginal infections. n general, the presence of lower genital tract infections poses a threat to the health of a woman. When infection is present in the pregnant patient, the consequences can be significant to the well-being of the mother and fetus. Early detection is important because maternal physiological alterations may hamper the infections' diagnosis and management, and the presence of the fetus may limit treatment. Pregnancy offers an excellent opportunity to establish whether the vaginal ecosystem has been altered or is infected. This, in turn, offers the physician an excellent opportunity for the investigation and treatment of these infections and for education of the patient. The possible side effects of cervicovaginal infections on the gestation of the fetus have been the focus of several investigations for the past several