title: A comparative study of clinical management strategies for vaginal discharge in family planning and genitourinary medicine settings.
abstract: OBJECTIVE
  To compare strategies for management of women with vaginal discharge in genitourinary medicine (GUM) and family planning (FP) settings.
  
  
  METHODS
  The setting was a centre housing both FP and GUM departments within a primary care trust in Scotland. The study participants were 200 women presenting with vaginal discharge. A randomised, controlled, crossover design was employed. Strategies typical of FP and GUM were performed on every participant in a randomised sequence. Day 1 diagnoses were made by the FP strategy (history and examination) and the GUM strategy (nearpatient microscopy added). Day 7 results were obtained from final analysis of all specimens. Days 1 and 7 results were compared with the reference standard provided by all the test results. The main outcome measures were incorrect diagnoses on Days 1 and 7.
  
  
  RESULTS
  On Day 1 the FP strategy resulted in significantly more incorrect diagnoses than the GUM strategy when compared with the reference standard (73 vs 32; p <0.001). On Day 7 the GUM strategy resulted in significantly more incorrect diagnoses than the FP strategy when compared with the reference standard (32 vs 17; p = 0.019).
  
  
  CONCLUSIONS
  Vaginal discharge can be managed effectively in community settings such as FP and primary care. The addition of near-patient microscopy produces a more accurate immediate diagnosis. The addition of a high vaginal swab for culture produces a more accurate final diagnosis. The costs of on-site microscopy must be considered.
authors.affiliation: The Sandyford Initiative, Glasgow, UK. catrionamelville@tiscali.co.uk
authors.forename: Catriona
authors.initials: C
authors.lastname: Melville
authors.forename: Rak
authors.initials: R
authors.lastname: Nandwani
authors.forename: Alison
authors.initials: A
authors.lastname: Bigrigg
authors.forename: Alex D
authors.initials: AD
authors.lastname: McMahon
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000592:standards*; D018592:Cross-Over Studies; D046508:Culture Techniques; D005194:Family Practice; D005260:Female; D006176:Gynecology; D006801:Humans; D008853:Microscopy / Q000592:standards; D008875:Middle Aged; D011320:Primary Health Care / Q000592:standards*; D012017:Referral and Consultation; D006113:United Kingdom; D019522:Vaginal Discharge / Q000175:diagnosis* / Q000382:microbiology*; D014932:Women's Health Services / Q000592:standards*