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The silent suffering women.

Jonsson et al' recently reported on a population-based study to assess the prevalence of lower genital tract symptoms in young women and the association between reported symptoms and past or present signs of STDs. The study found that the presence of leucocytosis was associated with reported discharge but not with pseudohyphae or clue cells. Vaginal pH was not reported. Definition of vaginal infections based on microscopy of wet smears is inadequate in this setting2 and, in the absence of vaginal fungal, aerobic and anaerobic culture, the opportunity to find other explanations for the association between discharge and leucocytosis has been missed. Other factors such as the use of chemical irritants, douching, self-medication and recent sexual activity do not appear to have been taken into account nor has participants' stage of menstrual cycle or method of contraception been recorded; the latter is relevant as different methods affect the vaginal flora in differ-