Medline ® Abstract for Reference 42

of 'Bacterial vaginosis'

42
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Predictive value of the clinical diagnosis of lower genital tract infection in women.
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Landers DV, Wiesenfeld HC, Heine RP, Krohn MA, Hillier SL
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Am J Obstet Gynecol. 2004;190(4):1004.
 
OBJECTIVE: We hypothesized that diagnostic approaches to lower genital tract infections are inaccurate and proposed this study to evaluate typical approaches.
STUDY DESIGN: Clinical diagnoses were made with symptoms, direct observation, wet mount, vaginal pH, and amines in 598 women with genital complaints. Laboratory testing for N gonorrhoeae, yeast, T vaginalis, C trachomatis, and bacterial vaginosis by Gram stain.
RESULTS: The most frequent symptoms were vaginal discharge (64%), change in discharge (53%), malodor (48%), and pruritus (32%). The infection rates were 46% bacterial vaginosis, 29% yeast, 12% trichomoniasis, 11% chlamydia or gonorrhea; 21% of the patients had no infection. The symptoms did not predict laboratory diagnosis. Clinical signs and symptoms with office-based tests and microscopy improved the accuracy of diagnoses. Amsel's clinical diagnosis of bacterial vaginosis was the most sensitive at 92%. The sensitivity of wet mount diagnosis of trichomoniasis was 62%, of yeast by microscopy was 22%, and of mucopus for theprediction of gonorrhea and/or chlamydia was 30%.
CONCLUSION: Symptoms alone should not be used to direct treatment in instances in which resources permit more complete evaluation with office-based testing that includes microscopy. Treatment failures or diagnostic uncertainty should prompt specific laboratory testing.
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Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh and Magee-Women's Research Institute, Pittsburgh, PA, USA. lande028@umn.edu
PMID