title: Are a speculum examination and wet mount always necessary for patients with vaginal symptoms? A pilot randomized controlled trial.
abstract: OBJECTIVE
  The suggested evaluation of vaginal symptoms is based on the wet mount diagnosis of candidiasis, trichomoniasis, and bacterial vaginosis. We wondered if patients with vaginal symptoms could be managed initially based solely on symptoms.
  
  
  METHODS
  This pilot randomized controlled trial was conducted in 2 urban family practice clinics and enrolled 46 premenopausal, nonpregnant women with acute vaginal symptoms. In the control arm, women were managed based on a speculum examination and wet mount. In the intervention arm, women were managed based on symptoms. Women were tested for gonorrhea, chlamydia, and trichomoniasis and called 2 weeks later to assess symptom resolution, adverse medication effects, need for revisit, and satisfaction with care.
  
  
  RESULTS
  Forty-one of 44 women (93%) felt better 2 weeks after the visit; 28 (64%) had complete resolution of symptoms. The intervention arm had slightly better resolution of symptoms (P=.046); there were other no differences between the 2 arms. Three women were diagnosed with sexually transmitted diseases (trichomoniasis, chlamydia, and gonorrhea).
  
  
  CONCLUSIONS
  Our pilot study suggests that in selected women it may be reasonable to initially manage vaginal complaints based on symptoms. These results should be confirmed in other larger trials. Testing for sexually transmitted diseases is important in our population.
authors.affiliation: Department of Family and Social Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA. Bronxdoc@gmail.com
authors.forename: Matthew
authors.initials: M
authors.lastname: Anderson
authors.forename: Andreas
authors.initials: A
authors.lastname: Cohrssen
authors.forename: Kathleen
authors.initials: K
authors.lastname: Klink
authors.forename: Danit
authors.initials: D
authors.lastname: Brahver
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D010808:Physical Examination; D010865:Pilot Projects; D014626:Vaginal Smears; D014627:Vaginitis / Q000175:diagnosis* / Q000382:microbiology; D055815:Young Adult