Abstract
Objective
The purpose of the present study was to compare the current diagnostic clinical and laboratory approaches to women with vulvovaginal discharge complaint. The secondary outcomes were to determine the prevalence of infections in our setting and to look for the relation between vulvovaginal infections and predisposing factors if present.
Method
Premenopausal women applying to our gynecology outpatient clinic with vaginal discharge complaint were enrolled prospectively into the study. Each patient evaluated clinically with direct observation of vaginal secretions, wet mount examination, whiff test, vaginal pH testing and chlamydia rapid antigen test. Each patient also evaluated microbiologically with vaginal discharge culture and gram staining. Clinical diagnosis was compared with the microbiological diagnosis (the gold standard). Diagnostic accuracy was measured with sensitivity, specificity, positive (ppv) and negative predictive values (npv).
Results
460 patients were included in the study. 89.8% of patients received a clinical diagnosis whereas only 36% of them had microbiological diagnosis. The sensitivity, specificity, ppv, npv of clinical diagnosis over microbiological culture results were 95, 13, 38, 82%, respectively. The most commonly encountered microorganisms by culture were Candida species (17.4%) and Gardnerella vaginalis (10.2%). Clinically, the most commonly made diagnoses were mixed infection (34.1%), bacterial vaginosis (32.4%) and fungal infection (14.1%). Symptoms did not predict laboratory results. Predisposing factors (DM, vaginal douching practice, presence of IUD and usage of oral contraceptive pills) were not found to be statistically important influencing factors for vaginal infections.
Conclusion
Clinical diagnosis based on combining symptoms with office-based testing improves diagnostic accuracy but is insufficient. The most effective approach also incorporates laboratory testing as an adjunct when a diagnosis is in question or treatment is failing.
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References
Landers DV, Wiesenfeld HC, Phillip Heine R, Krohn MA, Hillier SL (2004) Predictive value of the clinical diagnosis of lower genital tract infection in women. Am J Obstet Gynecol 190:1004–1010
Karasz A, Anderson M (2003) The vaginitis monologues: women’s experiences of vaginal complaints in a primary care setting. Soc Sci Med 56(5):1013–1021
Karaer A, Boylu M, Avsar AF (2005) Vaginitis in Turkish women: symptoms, epidemiologic–microbiologic association. Eur J Obstet Gynecol Reprod Biol 121:211–215
Schwiertz A, Taras D, Rusch K, Rusch V (2006) Throwing the dice for the diagnosis of vaginal complaints? Ann Clin Microbiol Antimicrobials 5:4
Berg AO, Heidrich FE, Fihn SD, Bergman JJ, Wood RW, Stamm WE et al (1984) Establishing the cause of genitourinary symptoms in women in a family practice. JAMA 251:620–625
Anderson MR, Klink K, Cohrssen A (2004) Evaluation of vaginal complaints. JAMA 291:1368–1379
Karaca M, Bayram A, Kocoglu ME, Gocmen A, Eksi F (2005) Comparison of clinical diagnosis and microbiological test results in vaginal infections. Clin Exp Obstet Gynecol 32(3):172–174
Mahadoni JW, Dekate R, Shrikhande AV (1998) Cytodiagnosis of discharge per vaginum. Indian J Pathol Microbiol 41(4):403–411
Shobeiri F, Nazari M (2006) A prospective study of genital infections in Hamedan, İran. Southeast Asian J Trop Med Public Health 37(Suppl 3):174–177
Wiesenfeld HC, Macio I (1999) The infrequent use of office-based diagnostic tests for vaginitis. Am J Obstet Gynecol 181:39–41
Langsford MJ, Dobbs FF, Morrison GM, Dance DAB (2002) The effect of introduction of a guideline on the management of vaginal discharge and in particular bacterial vaginosis in primary care. Fam Pract 18:253–257
Donders G (2001) We specialists in vulvovaginitis. Am J Obstet Gynecol 184:248
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Esim Buyukbayrak, E., Kars, B., Karsidag, A.Y.K. et al. Diagnosis of vulvovaginitis: comparison of clinical and microbiological diagnosis. Arch Gynecol Obstet 282, 515–519 (2010). https://doi.org/10.1007/s00404-010-1498-x
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DOI: https://doi.org/10.1007/s00404-010-1498-x