Diagnosis of vulvovaginitis: comparison of clinical and microbiological diagnosis.
OBJECTIVE
The purpose of the present study was to compare the current diagnostic clinical and laboratory approaches to women with vulvovaginal discharge complaint. The secondary outcomes were to determine the prevalence of infections in our setting and to look for the relation between vulvovaginal infections and predisposing factors if present.


METHODS
Premenopausal women applying to our gynecology outpatient clinic with vaginal discharge complaint were enrolled prospectively into the study. Each patient evaluated clinically with direct observation of vaginal secretions, wet mount examination, whiff test, vaginal pH testing and chlamydia rapid antigen test. Each patient also evaluated microbiologically with vaginal discharge culture and gram staining. Clinical diagnosis was compared with the microbiological diagnosis (the gold standard). Diagnostic accuracy was measured with sensitivity, specificity, positive (ppv) and negative predictive values (npv).


RESULTS
460 patients were included in the study. 89.8% of patients received a clinical diagnosis whereas only 36% of them had microbiological diagnosis. The sensitivity, specificity, ppv, npv of clinical diagnosis over microbiological culture results were 95, 13, 38, 82%, respectively. The most commonly encountered microorganisms by culture were Candida species (17.4%) and Gardnerella vaginalis (10.2%). Clinically, the most commonly made diagnoses were mixed infection (34.1%), bacterial vaginosis (32.4%) and fungal infection (14.1%). Symptoms did not predict laboratory results. Predisposing factors (DM, vaginal douching practice, presence of IUD and usage of oral contraceptive pills) were not found to be statistically important influencing factors for vaginal infections.


CONCLUSIONS
Clinical diagnosis based on combining symptoms with office-based testing improves diagnostic accuracy but is insufficient. The most effective approach also incorporates laboratory testing as an adjunct when a diagnosis is in question or treatment is failing.
Esim Buyukbayrak
Esra
E
Department of Gynecology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Kartal, Istanbul, Turkey. esraesim@yahoo.com
Kars
Bulent
B
Karsidag
Ayse Yasemin Karageyim
AY
Karadeniz
Bernan Ilkay
BI
Kaymaz
Ozge
O
Gencer
Serap
S
Pirimoglu
Zehra Meltem
ZM
Unal
Orhan
O
Turan
Mehmet Cem
MC
D000328:Adult; D002175:Candida / Q000302:isolation & purification*; D002181:Candidiasis, Vulvovaginal / Q000175:diagnosis / Q000382:microbiology; D015169:Colony Count, Microbial; D005260:Female; D006194:Gardnerella vaginalis / Q000302:isolation & purification*; D005840:Gentian Violet; D006801:Humans; D008875:Middle Aged; D010619:Phenazines; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D019522:Vaginal Discharge / Q000175:diagnosis / Q000382:microbiology; D016585:Vaginosis, Bacterial / Q000175:diagnosis* / Q000382:microbiology*; D014848:Vulvovaginitis / Q000175:diagnosis* / Q000382:microbiology*; D055815:Young Adult
C035863:Gram's stain; D010619:Phenazines; D005840:Gentian Violet