Gilles R. G. Monif, MD

The human papilloma viruses (HPVs) are among the widespread sexually transmitted pathogens infecting women. Like HIV, HPV–s

The CDC recommends that sexually active adolescent girls be screened for Chlamydia trachomatis infection at least annually and that all sexually active women aged 20 to 25 years and women aged 25 years or older who have risk factors also receive an annual screening.1 How well are these screening practices being observed and what are the implications?

Third-degree perineal lacerations reputedly occur in2.2% to 19% of vaginal deliveries in the UnitedStates.1,2 Breakdown of a third- or fourth-degreeperineal repair can lead to incontinence of stool or flatus,rectovaginal fistula, or sexual dysfunction.3,4 Infection atthe operative site occurs in up to 12% of cases,5 and a keyfactor in successful anal sphincter repair is the absence ofinfection.6

A new study confirmed the value of real-time polymerase chain reaction (PCR) assay as a rapid method of screening for group B streptococci (GBS) colonization during parturition.1 Using real-time automated PCR assay, DNA amplification testing, and standard culture, Edwards and colleagues1 comparatively looked at the detection of GBS colonization in women who were in the 35th to 37th week of pregnancy and in women who were about to give birth. A true-positive result was defined as a positive molecular test and a positive culture finding. Compared with culture, the sensitivity rate of PCR was 91.1%, the specificity was 96.0%, the predictive value was 87.8%, the negative predictive value was 97.1%, and the accuracy was 94.8%. As anticipated, PCR assay was more sensitive than DNA amplification testing (91.1% vs 79.3%). Neither specificity, positive predictive value, nor detection of GBS prevalence was statistically divergent.

Accurate diagnosis of nonviralinfectious diseases ofthe vagina is largely contingenton the clinician’s abilityto do a sophisticated wetmount/potassium hydroxide (KOH)preparation examination-more specificallywhat is termed a “level II wetmount examination” (Table). Clinicalassessment in conjunction with a properwet mount/KOH analysis will usuallyidentify the causative organism orsuggest exclusion of diagnostic possibilities(Figure).