Predictive value of the clinical diagnosis of lower genital tract infection in women.
OBJECTIVE
We hypothesized that diagnostic approaches to lower genital tract infections are inaccurate and proposed this study to evaluate typical approaches.


METHODS
Clinical diagnoses were made with symptoms, direct observation, wet mount, vaginal pH, and amines in 598 women with genital complaints. Laboratory testing for N gonorrhoeae, yeast, T vaginalis, C trachomatis, and bacterial vaginosis by Gram stain.


RESULTS
The most frequent symptoms were vaginal discharge (64%), change in discharge (53%), malodor (48%), and pruritus (32%). The infection rates were 46% bacterial vaginosis, 29% yeast, 12% trichomoniasis, 11% chlamydia or gonorrhea; 21% of the patients had no infection. The symptoms did not predict laboratory diagnosis. Clinical signs and symptoms with office-based tests and microscopy improved the accuracy of diagnoses. Amsel's clinical diagnosis of bacterial vaginosis was the most sensitive at 92%. The sensitivity of wet mount diagnosis of trichomoniasis was 62%, of yeast by microscopy was 22%, and of mucopus for the prediction of gonorrhea and/or chlamydia was 30%.


CONCLUSIONS
Symptoms alone should not be used to direct treatment in instances in which resources permit more complete evaluation with office-based testing that includes microscopy. Treatment failures or diagnostic uncertainty should prompt specific laboratory testing.
Landers
Daniel V
DV
Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh and Magee-Women's Research Institute, Pittsburgh, PA, USA. lande028@umn.edu
Wiesenfeld
Harold C
HC
Heine
R Phillip
RP
Krohn
Marijane A
MA
Hillier
Sharon L
SL
D000293:Adolescent; D000328:Adult; D002181:Candidiasis, Vulvovaginal / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005831:Genital Diseases, Female / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D006069:Gonorrhea / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D010808:Physical Examination / Q000592:standards*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011795:Surveys and Questionnaires; D014247:Trichomonas Vaginitis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D016585:Vaginosis, Bacterial / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology