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To assess level of contamination of neckwear worn by gynaecologists and obstetricians during routine working week.Multicentre randomised double blind crossover trial. Participants wore the same conventional ties for three days in one week and bow ties for the same period in second week.Two teaching and three district general hospitals in the midlands, Wales, and north England.15 registrars and senior registrars.A swab soaked in sterile saline was taken from specific area on ties at end of first and third working days and sent in transport medium for culture on chocolatised blood and MacConkey agar for 48 hours.Level of bacteriological growth assessed semiquantitatively (0 for no contamination; +++ for heavy contamination) after swabs had been cultured. At end of study the participants completed a questionnaire to assess their attitude toward wearing different types of necktie.12 doctors (80%) completed the study. Although bow ties were significantly less contaminated at end of first working day (z = -2[center dot]354, p = 0[center dot]019), this difference was not maintained; there was no difference in level of contamination on third day. Level of contamination did not increase between first and third day of wearing the same garment. One of the 10 doctors who returned the questionnaire found the bow tie very uncomfortable. All participants would consider wearing a bow tie if it proved to be less contaminated than a conventional tie.Although a significant difference in contamination was established between conventional and bow ties on first day of study, this difference was not confirmed on third day and there is unlikely to be any real association between tie type and bacterial contamination. Because of its negative image and difficulty to tie, the bow tie will probably remain a minority fashion.