Gynaecological and microbiological findings in women attending for a general health check-up

Two hundred apparently healthy sexually active women, 17-34 years of age, who had presented for a general health check-up at the Clinic of Dermatology and Venereology, Medical University, Plovdiv, Bulgaria, were asked about genital symptoms, sexual behaviour, contraceptive use and smoking habits, and examined for signs of genital infections. They were searched for genital chlamydial infection, gonorrhoea, trichomoniasis, bacterial vaginosis (BV) and vulvovaginal candidosis, syphilis and HIV. Polymerase chain reaction (PCR) was used for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in urine samples and the results were compared with direct immunofluorescence (DFA) and enzyme immunoassays (EIA) for C. trachomatis in urethral, cervical and urine samples. In 56 (28%) women, an STD and/or an STD-related condition were diagnosed. The prevalence of genital chlamydial infection, trichomoniasis, BV and vulvovaginal candidosis was 4.5%, 0.5%, 17.5% and 7.5% respectively. On direct questioning 39 (19.5%) women reported symptoms suggestive of an infection, while 58 (29%) had signs that may have been caused by genital infection. In urine the PCR tests detected more (3.5%) chlamydia-positive women than the DFA (2.5%) and EIA tests (1.5%). The urine PCR test was as sensitive as the DFA when testing cervical samples. The chlamydia-positive women and women with BV were less likely to have a steady partner than the controls. No woman had syphilis or HIV infection. The women with BV were more frequent users of an intrauterine device and were more likely to smoke heavily compared with other women. STDs and STD-related conditions are common among adult women who consider themselves gynaecologically healthy. Screening for genital infections among women in reproductive age attending for health check-up could improve women's reproductive health.