The Classic Approach to Diagnosis of Vulvovaginitis: A Critical Analysis

[摘要] Objective:To correlate the symptoms, signs and clinical diagnosis in women with vaginal discharge, based on thecombined weight of the character of the vaginal discharge and bedside tests, with the laboratory diagnosis.Methods:Women presenting consecutively to the women's health center with vaginal discharge wereinterviewed and examined for assessment of the quantity and color of the discharge. One drop of the materialwas then examined for pH and the whiff test was done; a wet mount in saline and in 10% KOH was examinedmicroscopically. The clinical diagnosis was based on the results of these assessments. Gram stain and cultures ofthe discharge were sent to the microbiology laboratory.Results:One hundred and fifty-threewomen with vaginal discharge with a clinical diagnosis of vulvovaginitis participatedin the study. Fifty-five (35.9%) had normal flora and the other 98 (64.1%) had true infectious vulvovaginitis(k agreement = 18%). According to the laboratory, the principal infectious micro-organism causing the vulvovaginitis wasCandidaspecies.Candidainfection was associated with pH levels of less than 4.5 (p< 0.0001, odds ratio = 4.74, 95% confidence interval: 2.35–9.5, positive predictive value 68.4%). The whiff test was positive inonly a small percentage of bacterial vaginosis (BV) (p= not significant (NS)). Clue cells were documented in 53.3%of patients with a laboratory diagnosis of BV (p< 0.02, positive predictive value 26.7%).Conclusions:The current approach to the diagnosis of vulvovaginitis should be further studied. The classical andtime-consuming assessments were shown not to be reliable diagnostic measures.

[学科分类] 妇产科学