Cervical infections in emergency department patients with vaginal bleeding.

Unlabelled: To the best of the authors' knowledge, no previous study has compared the prevalences of Chlamydia trachomatis (CT) or Neisseria gonorrhoeae (NG) cervical infection among pregnant and non-pregnant patients presenting to the emergency department (ED) with vaginal bleeding.

Objectives: To determine the prevalence of these infections in a simultaneously assembled cohort, and to determine whether pregnancy is associated with altered rates of CT or NG cervical infection among patients with vaginal bleeding.

Methods: This was a prospective, seven-month, cross-sectional study of a convenience sample of patients (aged > or = 15 years) who presented to an urban, teaching ED with the chief complaint of vaginal bleeding. A urine pregnancy test was administered to each patient. Cervical swab specimens were analyzed for CT or NG via polymerase chain reaction technology (DNA probe). The hospital laboratory's baseline 18% rate of positive tests was used for sample size planning. Chisquare analysis and Fisher's exact test, where appropriate, were used to compare pregnant and non-pregnant patient groups.

Results: Cervical infection rates did not differ between pregnant and non-pregnant patients. Testing for CT showed that 13 of 114 (11%) of the pregnant patients were positive, while 11 of 147 (8%) non-pregnant patients tested positive (chi(2) = 0.759, p = 0.384). Testing for NG revealed that seven of 114 (6%) pregnant patients tested positive, while 16 of 147 (11%) non-pregnant patients tested positive (chi(2) = 1.256, p = 0.262). Combined testing showed that 18 of 114 (16%) of the pregnant patients and 25 of 147 (17%) of the non-pregnant patients harbored a cervical infection with one or both pathogens (chi(2) = 0.009, p = 0.925).

Conclusions: The prevalence of CT or NG cervical infection in pregnant patients presenting to the ED with vaginal bleeding is 16%. Pregnant and non-pregnant patients with vaginal bleeding are at similar risks for having CT or NG cervical infection. Cervical swab specimens should be obtained in all patients with vaginal bleeding.