Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter in Response to Previous Publication
90 (
2
); 258-259
doi:
10.25259/IJDVL_114_2024

Authors’ reply

Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
Corresponding author: Prof. Somesh Gupta, Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India. someshgupta@aiims.edu
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Yadav D, Singh S, Dhawan B, Sood S, Gupta S. Clarifications and reflections on clinical and microbiological characteristics of cervical discharge. Indian J Dermatol Venereol Leprol. 2024;90:258–9. doi: 10.25259/IJDVL_114_2024

Dear Editor,

We thank the correspondents for showing interest in our work and for bringing forth important aspects.1 Our study looked at the clinical and microbiological characteristics of women with cervical discharge as part of cervicitis and pelvic inflammatory disease (PID). We also studied the post-treatment (syndromic management) response, both clinical and microbiological, in these cases.2

The clinical records of 70 cases were analysed at baseline, while microbiological analysis [bacterial culture and polymerase chain reaction (PCR)] were available for 67 cases and there were no controls in our study. Hence, the heading of Table 1 of original publication is incorrect and should be read as ‘demographic and clinical profile of cases’. We apologise for the same. The post-syndromic treatment records of 32 cases were available amongst which test of cure/ microbiological results of 28 cases were available. While analysing the data, clinical or microbiological or post-treatment results, the respective denominators were used. Hence, the incongruity of the denominator is due to difference in the number of patient records available at different time points, this being a retrospective analysis.

Table 1: Pre- and post-treatment results of culture and molecular tests of endocervical swabs of cases (n = 28)
Total n = 28 (%)
Cervicitis n = 13 (%)
Pelvic inflammatory disease n = 15 (%)
Pre-treatment Post-treatment Pre-treatment Post-treatment Pre-treatment Post-treatment
Infectious etiology 20 (71.4) 9 (32.1) 9 (69.2) 5 (38.4) 11 (73.3) 4 (26.6)
Mycoplasma hominis (culture) 2 (7.1) 2 (7.1) 1 (7.6) 1 (7.6) 1 (6.6) 1 (6.6)
Mycoplasma hominis (PCR*) 3 (10.7) 2 (7.1) 1 (7.6) 1 (7.6) 2 (13.3) 1 (6.6)
Ureaplasma species (culture) 13 (46.4) 6 (21.4) 6 (46.1) 4 (30.7) 7 (46.6) 2 (13.3)
Ureaplasma species (PCR*) 18 (64.3) 8 (28.5) 8 (61.5) 5 (38.4) 10 (66.6) 3 (20)
Chlamydia trachomatis (PCR*) 5 (17.8) 1 (3.6) 1 (7.6) 1 (7.6) 4 (26.6) 0 (0)
Neisseria gonorrhoeae (culture) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
: Polymerase chain reaction

Grading of clinical improvement as ‘minimal/none’, ‘moderate’ and ‘complete’ was done both by the patient and the examiner. The post-treatment clinical response in cases with Mycoplasma hominis infection was ‘minimal/none’ and ‘complete’ improvement in one case each of cervicitis and PID, respectively. For Ureaplasma species, amongst 8 cases of cervicitis, majority showed ‘minimal/none’ clinical improvement with syndromic management (6/8, 75%), while one case each (1/8, 12.5%) showed ‘moderate’ and ‘complete’ improvement respectively. For ten PID cases which had Ureaplasma species positivity; ‘complete’ clinical improvement was seen in 8 cases (80%) and one case each showed ‘minimal/none’ and ‘moderate’ improvement, respectively. The probable reason for greater clinical response in those treated with doxycycline (as part of KIT 6 of National AIDS Control Organisation, India) versus azithromycin (as part of KIT 1) could be due to increased resistance of non-gonococcal, non-chlamydial organisms to azithromycin compared to doxycycline.3 The microbiological response to treatment in these cases showed similar trend as clinical improvement, however microbiological cure was less. Post-treatment Ureaplasma species was detected in 5 out of 13 cases (38.4%) of cervicitis and 3 out of 15 (20%) cases of PID respectively [Table 1]. We found Ureaplasma species by PCR in the majority of the cases at baseline, both overall (25/67, 37.3%) and separately for cervicitis (12/41, 29.3%) and PID (13/26, 50%).

As pointed out, positivity of Ureaplasma species PCR was more in treated cervicitis cases (38.4%, 5/13; Table 3 of original publication) compared to baseline (29.3%, 12/41; Table 2 of original publication).2 However, if we only consider results of 28 follow-up cases, then the pre-treatment positivity for Ureaplasma species by PCR was 8 out of 13 cases of cervicitis (61.5%) [Table 1]. Hence, it is tough to draw firm conclusions from the data as the numbers are small and data was retrieved retrospectively. Nevertheless, we agree with correspondents that Ureaplasma species may just be a bystander and not an actual causative agent. We are also of the opinion that quantitative PCR might have been more conclusive in establishing the causation. In addition, further characterisation of Ureaplasma species into U. parvum, U. urealyticum would have added more clarity regarding causation. However, despite these suggestions, it is still not appropriate to assess causation based on a retrospective study design.

Regarding the concern raised in the study by Dhawan et al., the main objective of the study was to assess the prevalence of Chlamydia trachomatis.4 They did not assess the role of other pathogens like Ureaplasma species, Mycoplasma etc. Hence it doesn’t seem relevant to compare the two studies with different objectives, and timelines, inclusion and exclusion criterias (only cervicitis and PID cases were included; exclusion of cases with other sexually transmitted infections, incomplete clinical and microbiological records). Of note, the rates of positivity of Chlamydia trachomatis infection in our study and study by Dhawan et al. were similar (14.9% vs 8.5–12.5%).2,4

Regarding the claim in the conclusion, we found ‘complete’ clinical improvement in 15 out of 32 cases (46.9 %). Microbiologically, infectious etiology was seen in 44.7% (30/67 cases) at baseline versus 32.1% (9/28 cases) post-treatment overall. Correspondents have emphasised only on the cervicitis cases (36.5% vs. 38.4%). On analysis of only the 28 follow-up cases, infectious etiology was seen in 9 (32.1%) cases post-treatment versus 20 (71.4%) cases at baseline, showing resolution in more than 50% cases. We would again like to thank the correspondents for giving attention to our work. To conclude, the limitations of our study were retrospective study design, small sample size, inability to further characterise Ureaplasma species and conduct quantitative PCR. There is a need for long- term follow up studies with larger sample size from our population to determine the role of non-gonococcal non-chlamydia pathogens causing cervical discharge.

Declaration of patient consent

Patient’s consent is not required as there are no patients in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

References

  1. , , . Letter to the editor regarding “Laboratory detection of bacterial pathogens and clinical and laboratory response of syndromic management in patients with cervical discharge: A retrospective study”. Indian J Dermatol Venereol Leprol. 2024;90:256-7.
    [Google Scholar]
  2. , , , , . Laboratory detection of bacterial pathogens and clinical and laboratory response of syndromic management in patients with cervical discharge: A retrospective study. Indian J Dermatol Venereol Leprol.. 2023;89:431-35.
    [Google Scholar]
  3. , , . Prevalence and antibiotic susceptibility of Mycoplasma hominis and Ureaplasma urealyticum in genital samples collected over 6 years at a Serbianuniversity hospital. Indian J Dermatol Venereol Leprol. 2016;82:37-41.
    [Google Scholar]
  4. , , , , . Prevalence of genital chlamydia trachomatis at a Tertiary care Hospital in North India: A 10 years observational study. Indian J Sex Trasm Dis. 2023;44:104-5.
    [Google Scholar]

Fulltext Views
248

PDF downloads
183
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections