A Clinic-based System for Monitoring the Quality of Techniques for the Diagnosis of Gonorrhea

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The author describes a clinic-based system that monitors the quality of techniques for diagnosis of gonorrhea by continuous comparison of the results of gram-stained smears of urethral and cervical specimens with the corresponding cultures. Discrepant results are immediately reviewed. During a two-year period, the system detected two defects in culture incubation, visual defects in a laboratory technician, and three unexplained reductions in cultural sensitivity. The system motivates clinicians and laboratory technicians to maintain a high level of quality control. In 11,474 comparisons of urethral smear and culture results, there was agreement in 96.9%, while the smear alone was positive in 1.6% and the culture alone in 1.5%. Review of positive-smear-negative-culture discrepancies indicated that most smears judged “false-positive” were so classified on the basis of false-negative cultures. In a study of 1,331 women, the endocervical smears identified 60% (273/455) of those with positive cultures. There were 3.2% positive-smear-negative-culture discrepancies. Many of these may have represented false-negative cultures.

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