Abstract
The current approach to diagnosing vulvovaginal symptoms is both flawed and inadequate. Mistakes occur at the level of the patient herself, her provider, and the sensitivity of office-based tests. Often, the differential diagnosis is so broad that providers may overlook some of the possibilities. A diagnostic algorithm which separates women into either a normal or elevated vaginal pH can successfully classify most women with vaginitis. Based on the amine test, vaginal leukocytes, and vaginal parabasal cells, those with an elevated pH can be placed into further diagnostic categories. Such an algorithm helps to prioritize different diagnoses and suggest appropriate ancillary tests.
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Lipsky MS, Waters T, Sharp LK: Impact of vaginal antifungal products on utilization of health care services: Evidence from physician visits. J Am Board Fam Pract 2000, 13:178–182.
Koumans EH, Kendrick JS, CDCBacterial Vaginosis Working Group: Preventing adverse sequelae of bacterial vaginosis: A public health program and research agenda. Sex Transm Dis 2001, 28:292–297.
Anderson MR, Klink K, Cohrssen A: Evaluation of vaginal complaints. JAMA 2004, 291:1368–1379. This paper presents a very thorough review of the literature on vaginitis patient symptoms, findings with each office test, and actual diagnosis.
Marazzo J: Vulvovaginal candidiasis. Brit Med J 2003, 326:993–994.
Ferris DG, Dekle C, Litaker MS: Women’s use of over-thecounter antifungal medications for gynecological symptoms. J Fam Pract 1996, 42:595–600.
Ferris DG, Nyirjesy P, Sobel JD, et al.: Over-the-counter antifungal drug misuse associated with patient-diagnosed vulvovaginal candidiasis. Obstet Gynecol 2002, 99:419–425. This prospective study highlights many of the inaccuracies associated with self-diagnosis.
Allen-Davis JT, Beck A, Parker R, et al.: Assessment of vulvovaginal complaints: Accuracy of telephone triage and in-office diagnosis. Obstet Gynecol 2002, 99:18–22.
Wiesenfeld HC, Macio I: The infrequent use of office-based diagnostic tests for vaginitis. Am J Obstet Gynecol 1999, 181:39–41.
Ledger WJ, Polaneczky MM, Yih MC, et al.: Difficulties in the diagnosis of Candida vaginitis. Infect Dis Clin Pract 2000, 9:66–69.
Landers DV, Wiesenfeld HC, Heine RP, et al.: Predictive value of the clinical diagnosis of lower genital tract infection in women. Am J Obstet Gynecol 2004, 190:1004–1010.
Sobel JD, Wiesenfeld HC, Martens M, et al.: Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. N Engl J Med 2004, 351:876–883.
Soper D: Trichomoniasis: Under control or undercontrolled? Am J Obstet Gynecol 2004, 190:281–290.
Geisler WM, Yu S, Venglarik M, Schwebke JR: Vaginal leucocyte counts in women with bacterial vaginosis: relation to vaginal and cervical infections. Sex Transm Infect 2004, 80:401–405.
Sobel JD: Nontrichomonal purulent vaginitis: Clinical approach. Curr Infect Dis Rep 2000, 2:501–505. This paper presents a thorough discussion of how to evaluate women with purulent vaginitis.
Roy S, Caillouette JC, Faden JS, et al.: Improving appropriate use of antifungal medications: the role of an over-thecounter vaginal pH self-test device. Infect Dis Obstet Gynecol 2003, 11:209–216.
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Nyirjesy, P., Sobel, J.D. advances in diagnosing vaginitis: Development of a new algorithm. Curr Infect Dis Rep 7, 458–462 (2005). https://doi.org/10.1007/s11908-005-0048-3
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DOI: https://doi.org/10.1007/s11908-005-0048-3