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Evaluation Of Vaginal Complaints.

Matthew R. Anderson, Kathleen A Klink, Andreas Cohrssen
Published 2004 · Medicine
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CONTEXT Vaginal symptoms are one of the most common reasons for gynecological consultation. Clinicians have traditionally diagnosed vaginal candidiasis, bacterial vaginosis, and vaginal trichomoniasis using some combination of physical examination, pH, the wet mount, and the whiff test. OBJECTIVES To evaluate the role of the clinical examination and determine the positive and negative likelihood ratios (LRs) for the diagnosis of vaginal candidiasis, bacterial vaginosis, and vaginal trichomoniasis. DATA SOURCES Using a structured literature review, we abstracted information on sensitivity and specificity for symptoms, signs, and office laboratory procedures. We chose published (1966 to April 2003) articles that appeared in the MEDLINE database and were indexed under the combined search terms of diagnosis with vaginitis, vaginal discharge, candidiasis, bacterial vaginosis, and trichomoniasis. STUDY SELECTION Included studies of symptomatic premenopausal women seen in primary care settings. Tests were evaluated only if they would provide diagnostic information during the office visit and were compared with an acceptable criterion standard. DATA EXTRACTION All 3 authors extracted the data and computed sensitivity and specificity from each article independently. The absence of standard definitions for symptoms and signs made it impossible to combine results across studies. DATA SYNTHESIS Symptoms alone do not allow clinicians to distinguish confidently between the causes of vaginitis. However, a patient's lack of itching makes candidiasis less likely (range of LRs, 0.18 [95% confidence interval [CI], 0.05-0.70] to 0.79 [95% CI, 0.72-0.87]) and lack of perceived odor makes bacterial vaginosis unlikely (LR, 0.07 [95% CI, 0.01-0.51]). Similarly, physical examination signs are limited in their diagnostic power. The presence of inflammatory signs is associated with candidiasis (range of LRs, 2.1 [95% CI, 1.5-2.8] to 8.4 [95% CI, 2.3-31]). Presence of a "high cheese" odor on examination is predictive of bacterial vaginosis (LR, 3.2 [95% CI, 2.1-4.7]) while lack of odor is associated with candidiasis (LR, 2.9 [95% CI, 2.4-5.0]). Office laboratory tests, particularly microscopy of vaginal discharge, are the most useful way of diagnosing these 3 conditions. CONCLUSIONS The cause of vaginal complaints may be easily diagnosed when typical findings appear in microscopy. However, the poor performance of individual symptoms, signs, and office laboratory tests often makes it problematic to identify the cause of vaginal symptoms.



This paper is referenced by
Vulvovaginal Disease : An Evidence-Based Approach to Medical Management
Jeff R M Andrews (2009)
10.15570/ACTAAPA.2015.2
Treatment of vulvovaginal candidiasis: a review of the literature.
Andraž Dovnik (2015)
Symptômes urinaires bas et bandelette normale: a quoi penser?
Naouaf Sabeh (2012)
The comparison of two methods of vaginal discharge with and without speculum examination diagnosis of trichomonas infection
Nahid Khodakarami (2010)
10.33631/duzcesbed.558836
Vulvovajinal Enfeksiyon Tanı Yöntemlerinin Karşılaştırılması ve Predispozan Faktörlerin Etkilerinin İncelenmesi
Hilal Türkmen Albayrak (2020)
10.14260/JEMDS/2015/2317
CHANGING TRENDS OF CANDIDA ISOLATES AND THEIR ANTIFUNGAL SUSCEPTIBILITY PATTERN IN VULVOVAGINAL CANDIDIASIS CASES OF TRIPURA, NORTH EAST INDIA
Jhinuk Basu Mullick (2015)
FLOW (finding lasting options for women)
Courtney Howard (2011)
10.1111/myc.12623
Phenotypic and genotypic characteristics of Candida albicans isolates from bloodstream and mucosal infections
Marina Mandelblat (2017)
10.1111/j.1440-0960.2011.00860.x
Chronic vulvovaginal candidiasis: what we know and what we have yet to learn.
Gayle Fischer (2012)
10.1007/978-90-313-6614-9_35
NHG-Standaard Fluor vaginalis
H. J. Dekker (2009)
10.1517/17530059.2010.488688
Diagnostic techniques for bacterial vaginosis and vulvovaginal candidiasis - requirement for a simple differential test.
Jack D. Sobel (2010)
Risk Factors Associated With Vulvo vaginal Candidiasis among Women in a Rural Community in Western Uttar Pradesh , India
Mansimrat P. Singh (2016)
10.1157/13079150
Enfermedades de transmisión sexual
R. Savall (2005)
10.1093/geronb/gbu105
Prevalence of bacterial vaginosis and Candida among postmenopausal women in the United States.
Joscelyn N Hoffmann (2014)
ESTUDO COMPARATIVO, RANDOMIZADO PARA AVALIAR A EFICÁCIA TERAPÊUTICA DA MENTHA CRISPA E DO SECNIDAZOL NO TRATAMENTO DA TRICOMONÍASE
Programa de Pós-graduação (2010)
Individual Va 949 Part F | 50 50 . Individual Variation in Body Odor
Jan Havlíček (2017)
10.1016/j.ijgo.2008.04.014
Efficacy and tolerance of metronidazole and miconazole nitrate in treatment of vaginitis.
Fábio Afonso Peixoto (2008)
10.3389/fmicb.2020.00718
Saccharomyces cerevisiae-Based Probiotics as Novel Antimicrobial Agents to Prevent and Treat Vaginal Infections
Roberta Gaziano (2020)
10.1016/j.medmal.2019.01.011
PRISM study: Comparison of a nystatin-neomycin-polymyxin B combination with miconazole for the empirical treatment of infectious vaginitis.
J M Bohbot (2019)
10.1016/j.bpobgyn.2014.07.003
Desquamative inflammatory vaginitis.
Orna Reichman (2014)
10.1128/JCM.01168-09
Efficient Diagnosis of Vulvovaginal Candidiasis by Use of a New Rapid Immunochromatography Test
Agnès Marot-Leblond (2009)
10.1007/978-3-319-61621-6_23
Approach to Diagnosis of Vulvovaginitis
Orna Reichman (2019)
10.1111/myc.12292
Guideline: vulvovaginal candidosis (AWMF 015/072), S2k (excluding chronic mucocutaneous candidosis).
Werner Mendling (2015)
Vaginitis in Nonpregnant Patients
Catherine M. Leclair ()
10.1007/s11908-015-0488-3
The Role of PCR in the Diagnosis of Candida Vulvovaginitis—a New Gold Standard?
Jack D. Sobel (2015)
10.1016/j.jpag.2012.09.005
Abnormal vaginal pH and Mycoplasma genitalium infection.
Jill S. Huppert (2013)
10.1007/s13224-016-0879-x
Study to Evaluate Targeted Management and Syndromic Management in Women Presenting with Abnormal Vaginal Discharge
Veena Meena (2016)
10.1016/j.jadohealth.2006.12.010
Urinary symptoms in adolescent females: STI or UTI?
J. Huppert (2007)
10.1186/s12905-019-0748-8
Current patient perspectives of vulvovaginal candidiasis: incidence, symptoms, management and post-treatment outcomes
Junko Yano (2019)
10.1136/bmj.d7314
Persistent vaginitis
Gayle Fischer (2011)
10.5145/KJCM.2012.15.2.49
Vaginal Candida and Microorganisms Related to Sexual Transmitted Diseases in Women with Symptoms of Vaginitis
Kye Hyun Kim (2012)
In vitro antifungal activity of aqueous-ethanolic extract of Allium jesdianum against fluconazole-susceptible and -resistant human vaginal Candida glabrata isolates
S. Shahrokh (2017)
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