title: Improving appropriate use of antifungal medications: the role of an over-the-counter vaginal pH self-test device.
abstract: OBJECTIVE
  To determine whether patients can understand and use the vaginal pH device in the diagnosis of vaginitis. To compare whether vaginal pH readings determined by patients and healthcare providers are similar. To determine whether vaginal pH can reduce inappropriate over-the-counter (OTC) antifungal medication use and improve the correct diagnosis of vaginitis.
  
  
  METHODS
  One hundred and fifty-one women indicated their belief about the cause of their vaginal infection, read the instructions of the vaginal pH device package insert, used the device and interpreted the findings. The patient interpretations were compared with results obtained by healthcare providers, blinded to patient findings.
  
  
  RESULTS
  Over 96% of patients stated that they could easily read the instructions, use the vaginal pH device and interpret the readings. They obtained the same readings as healthcare professionals (Kappa = 0.9). Restricting the use of OTC antifungal medications to those individuals with vaginitis symptoms and vaginal pH < or = 4.5 significantly reduced inappropriate use by approximately 50%, Fisher's exact test, p-value = 0.018. Conversely, seeking healthcare provider assessment with vaginal pH > 4.5, leads to correct diagnosis of vaginitis.
  
  
  CONCLUSIONS
  The vaginal pH device can be used as an OTC diagnostic tool by consumers when a vaginal infection is suspected. Vaginal pH readings would direct patients whether to purchase an antifungal medication or seek professional diagnosis from a healthcare provider. Understanding and use of this vaginal pH device could reduce inappropriate use of OTC antifungal medications by approximately 50% and improve the correct diagnosis of vaginitis.
authors.affiliation: Keck School of Medicine of the University of Southern California, Women's and Children's Hospital, Los Angeles, CA 90033, USA. subirro@usc.edu
authors.forename: Subir
authors.initials: S
authors.lastname: Roy
authors.forename: James C
authors.initials: JC
authors.lastname: Caillouette
authors.forename: Joel S
authors.initials: JS
authors.lastname: Faden
authors.forename: Tapon
authors.initials: T
authors.lastname: Roy
authors.forename: Diana E
authors.initials: DE
authors.lastname: Ramos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D002181:Candidiasis, Vulvovaginal / Q000175:diagnosis* / Q000188:drug therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008875:Middle Aged; D004366:Nonprescription Drugs / Q000627:therapeutic use*; D011933:Reagent Kits, Diagnostic; D018570:Risk Assessment; D012651:Self Medication / Q000592:standards* / Q000639:trends; D016353:Self-Examination / Q000295:instrumentation; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014627:Vaginitis / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000935:Antifungal Agents; D004366:Nonprescription Drugs; D011933:Reagent Kits, Diagnostic