title: Throwing the dice for the diagnosis of vaginal complaints?
abstract: BACKGROUND
  Vaginitis is among the most common conditions women are seeking medical care for. Although these infections can easily be treated, the relapse rate is high. This may be due to inadequate use of the diagnostic potential.
  
  
  METHODS
  We evaluated the misjudgement rate of the aetiology of vaginal complaints. A total of 220 vaginal samples from women with a vaginal complaint were obtained and analysed for numbers of total lactobacilli, H2O2-producing lactobacilli, total aerobic cell counts and total anaerobic cell counts including bifidobacteria, Bacteroides spp., Prevotella spp. Additionally, the presence of Atopobium vaginae, Gardnerella vaginalis, Candida spp. and Trichomonas vaginalis was evaluated by DNA-hybridisation using the PCR and Affirm VPIII Microbial Identification Test, respectively.
  
  
  RESULTS
  The participating physicians diagnosed Bacterial vaginosis (BV) as origin of discomfort in 80 cases, candidiasis in 109 cases and mixed infections in 8 cases. However, a present BV, defined as lack of H2O2-lactobacilli, presence of marker organisms, such as G. vaginalis, Bacteroides spp. or Atopobium vaginae, and an elevated pH were identified in only 45 cases of the women examined. Candida spp. were detected in 46 cases. Interestingly, an elevated pH corresponded solely to the presence of Atopobium vaginae, which was detected in 11 cases.
  
  
  CONCLUSIONS
  Errors in the diagnosis of BV and candida vulvovaginitis (CV) were high. Interestingly, the cases of misjudgement of CV (77%) were more numerous than that of BV (61%). The use of Amsel criteria or microscopy did not reduce the number of misinterpretations. The study reveals that the misdiagnosis of vaginal complaints is rather high.
authors.affiliation: Institute for Microecology, Herborn, Germany. andreas.schwiertz@mikrooek.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Schwiertz
authors.forename: David
authors.initials: D
authors.lastname: Taras
authors.forename: Kerstin
authors.initials: K
authors.lastname: Rusch
authors.forename: Volker
authors.initials: V
authors.lastname: Rusch
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification / Q000378:metabolism; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D006861:Hydrogen Peroxide / Q000032:analysis; D012008:Recurrence; D011795:Surveys and Questionnaires; D014623:Vaginal Diseases / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy; D014627:Vaginitis / Q000175:diagnosis* / Q000188:drug therapy; D016585:Vaginosis, Bacterial / Q000175:diagnosis / Q000453:epidemiology
chemical_list: D000890:Anti-Infective Agents; D006861:Hydrogen Peroxide