Validity of the symptomatic approach used by nurses in diagnosing vaginal infections

• Published in: Journal of clinical nursing 2009-04, Vol.18 (7), p.1059-1068
• Main Authors: Kisa, Sezer, Taskin, Lale
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Algorithms; Candida albicans; Chi-Square Distribution; Decision Trees; Effectiveness; Female; Humans; Infection - diagnosis; Infection - microbiology; Infections; Medical History Taking - methods; Medical History Taking - standards; Middle Aged; Nurse's Role; Nurses; Nursing; Nursing Assessment - methods; Nursing Assessment - standards; Nursing Evaluation Research; Physical Examination; Prospective Studies; Reproductive system; Sensitivity and Specificity; Studies; Surveys and Questionnaires; Trichomonas; Trichomonas vaginalis; Turkey; vaginal discharge; Vaginal Discharge - diagnosis; Vaginal Discharge - microbiology; Validity; women; Womens health; Young Adult
• ISSN: 0962-1067; 1365-2702
• DOI: 10.1111/j.1365-2702.2008.02702.x

Aims and objectives.  To examine the validity and effectiveness of a symptomatic approach based on symptoms, administered by a nurse working in women’s health area, in identifying vaginal infections in women with or without vaginal discharge. Design.  Survey. Methods.  Between November 2005–August 2006, 300 married women were included. A questionnaire and vaginal discharge assessment form were used for data collection. The modified algorithm of a symptomatic approach without speculum examination was used to manage participants. Three diagnoses were made for each participant. The first diagnosis was made by the research nurse using the vaginal discharge assessment form; the second diagnosis is the clinical diagnosis which was made after the gynaecological examination by a physician; and the third diagnosis is the microscopic diagnosis made by the physician when assessing the collected specimens. Results.  In the methodological part of this study, the sensitivity, specificity, positive predictive value and negative predictive value of the symptomatic approach were 91·5, 69·7, 87·7 and 77·5%, respectively. The symptomatic approach had 27·7% sensitivity for bacterial vaginosis, 16·6% for trichomonas vaginalis and 62·8% for candida albicans, compared to the microscopic results. The sensitivity of the approach was higher for the identification of candidiasis compared to bacterial vaginosis and trichomonas vaginalis. Conclusion.  From the results, it is suggested that the symptomatic approach model can be used by nurses who work in women’s health area to diagnose vaginal infections. Relevance to clinical practice.  This study showed that trained clinician nurses will be able to diagnose and manage vaginal infections – especially candidiasis – by using the symptomatic approach. Moreover, the symptomatic approach will encourage women not to delay or fail to seek treatment for their health problems, especially for vaginal infections in conservative societies.