Diagnosis of vulvovaginitis: comparison of clinical and microbiological diagnosis

• Published in: Archives of gynecology and obstetrics 2010-11, Vol.282 (5), p.515-519
• Main Authors: Esim Buyukbayrak, Esra, Kars, Bulent, Karsidag, Ayse Yasemin Karageyim, Karadeniz, Bernan Ilkay, Kaymaz, Ozge, Gencer, Serap, Pirimoglu, Zehra Meltem, Unal, Orhan, Turan, Mehmet Cem
• Format: Article
• Language: English
• Subjects: Adult; Candida - isolation & purification; Candidiasis, Vulvovaginal - diagnosis; Candidiasis, Vulvovaginal - microbiology; Colony Count, Microbial; Endocrinology; Female; Gardnerella vaginalis - isolation & purification; General Gynecology; Gentian Violet; Gynecology; Human Genetics; Humans; Infections; Laboratories; Medicine; Medicine & Public Health; Middle Aged; Obstetrics/Perinatology/Midwifery; Phenazines; Predictive Value of Tests; Prevalence; Prospective Studies; Sensitivity and Specificity; Vaginal Discharge - diagnosis; Vaginal Discharge - microbiology; Vaginosis, Bacterial - diagnosis; Vaginosis, Bacterial - microbiology; Vulvovaginitis - diagnosis; Vulvovaginitis - microbiology; Young Adult
• ISSN: 0932-0067; 1432-0711
• DOI: 10.1007/s00404-010-1498-x

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. Method 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. Conclusion 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.