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Gonorrhea as a marker of chlamydial infection.

To the Editor.— In the April 17, 1987, issue of JAMA , an article by Washington et al 1 argues for cost-effectiveness of combined ampicillin-tetracycline treatment of endocervical gonorrhea because it will eliminate coinfection with Chlamydia trachomatis . The reasoning of the authors is that gonorrhea is a good marker for chlamydial infection because 26% to 48% 2-4 of female patients with gonorrhea also are infected with Chlamydia . Their argument is correct, as far as it goes, but possesses a fatal flaw. The problem is that the figures cited state a converse relationship to that required to determine the efficacy of gonorrhea as a marker for Chlamydia . The significant figure would be the percentage of individuals with chlamydial infections who also have gonorrhea. Study.— In the last two months, we received 577 endocervical smears, studied for both organisms by culture for Neisseria gonorrhoeae and direct fluorescent antibody smear (Syva Microtrak) for Chlamydia