Diagnosis of vaginitis in general practice
Noe-Nygaard, E.; Kragstrup, J.
Ugeskrift for Laeger 149(35): 2325-2327
1987
ISSN/ISBN: 0041-5782 PMID: 3330325 Document Number: 302811
The diagnostic values of symptoms, clinical assessment and laboratory investigations for the microbiological diagnosis were investigated in 106 women who sought their general practitioners on account of discharge or irritation from the vagina. Culture from the vaginal secretion revealed Candida albicans in 48% and Gardnerella vaginalis in 49% while other organisms (e.g., Trichomonas vaginalis, Chlamydia trachomatis and Neisseria gonorrhoeae) were cultured in only a few individuals. Mixed infections occurred in 25% and no growth was obtained in 11% of the patients. The predictive value of demonstration of fungi by direct microscopic examination was 100% while the predictive value of negative microscopic findings was only 65%. The predictive value of a negative finding was greatest for histories of smarting and itching (80%) which was thus the most sensitive diagnostic parameter for fungal infection. In cases of Gardnerella vaginalis, high pH values (> 4.5) were found to be the most informative parameters with a positive predictive value of 66% and a negative predictive value of 68%. The occurrence of e.g. both "clue-cells" and high pH did not increase the diagnostic probability. All of the patients with Trichomonas infections were found by primary microscopic examination prior to culture. Leukocytosis was demonstrated wit all positive cultures for Chlamydia trachomatis, Neisseria gonorrhoeae, Streptococcus haemolytica and Staphylococcus aureus. It is uncertain whether the microbiological diagnosis constitutes the rational basis for the treatment of the vaginitis in all of the cases but, if a definite microbiological diagnosis is desired, culture can scarcely be replaced.