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Huppert JS, Hesse EA, Bernard MC, Bates JR, Gaydos CA, Kahn JA. Accuracy and trust of self-testing for bacterial vaginosis. J Adolesc Health 2012; 51:400-5. [PMID: 22999842 PMCID: PMC3457017 DOI: 10.1016/j.jadohealth.2012.01.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 01/17/2012] [Accepted: 01/19/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Two point-of-care tests are available to detect bacterial vaginosis (BV), a common vaginal condition. This study aimed to (1) compare the accuracy of two self-performed BV tests with clinician-performed BV tests and with clinical diagnosis of BV; and (2) compare trust of results for self-performed BV testing with clinician-performed BV testing. METHODS Participants (14-22 years old) in a study assessing self-testing for Trichomonas vaginalis were also asked to perform a self-test for BV (using a pH or sialidase test). Results were compared with clinician-performed tests and with clinical diagnosis of BV (defined by modified Amsel criteria). A two-item subscale from a larger acceptability scale was used to assess trust at baseline, after testing, and after discussion of results. RESULTS All 131 women performed self-BV testing correctly. Agreement between self- and clinician-performed tests was good (κ: .5-.7) Compared with clinical diagnosis of BV, self-pH was 73% sensitive and 67% specific, and self-sialidase was 40% sensitive and 90% specific. Trust in self-performed BV testing was lower than trust in clinician-performed BV testing at baseline, but increased after testing and discussion of results. CONCLUSIONS Young women can perform self-tests for BV with reasonable accuracy, which could increase testing when pelvic examinations are not feasible. Trust in self-testing increased after experience and after discussion of test results. Although the pH test is available over the counter, young women may continue to rely on clinicians for testing.
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Affiliation(s)
- Jill S. Huppert
- Associate Professor of Pediatrics, Obstetrics and Gynecology, Division of Pediatric and Adolescent Gynecology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue – MLC 4000, Cincinnati, OH 45229-3039, USA, Office: (513) 636-7042, Fax: (513) 636-8844,
| | - Elizabeth A. Hesse
- Clinical Research Coordinator, Division of Adolescent Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA
| | - Marianne Claire Bernard
- Student Associate, Division of Adolescent Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA
| | - Justin R. Bates
- Data Manager, Division of Adolescent Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA
| | - Charlotte A. Gaydos
- Professor, School of Medicine, Division of Infectious Diseases, STD Laboratory, Johns Hopkins University, 855 North Wolfe Street, 530 Rangos Building, Baltimore, MD 21205, USA
| | - Jessica A. Kahn
- Associate Professor, Pediatrics, Division of Adolescent Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA
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Diagnosis of vaginal discharge by wet mount microscopy: a simple and underrated method. Obstet Gynecol Surv 2012; 66:359-68. [PMID: 21851750 DOI: 10.1097/ogx.0b013e31822bdf31] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Vaginal discharge is highly variable in quality and quantity among different individuals, and even in the same individual during different periods of life. Vaginal discharge is most commonly caused by infection with sexually transmitted organisms or increased colonization by different facultative pathogenic microorganisms (i.e., Gardnerella vaginalis). Noninfectious causes of vaginal discharge are quite rare (10% noninfectious as compared to 90% infectious causes). Most common in women with a vaginal infection is bacterial vaginosis (40%-50% of cases), followed by vulvovaginal candidosis (20%-25%), and then trichomoniasis (15%-20%). If infection is suspected as the primary cause, a sample of the vaginal discharge should be taken and examined microscopically. When evaluating vaginal secretions by phase-contrast wet mount microscopy, knowledge of what is normal versus abnormal is very important. Knowledge of the sensitivity and specificity of wet mount microscopy in different clinical settings is also important. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES After completing this CME activity, physicians should be better able to evaluate lifetime changes in vaginal secretions, characterize the physiological and pathological appearance of vaginal discharge, assess the clinical practicality and usefulness of wet mount microscopy and use wet mount microscopy to diagnose bacterial vaginosis and other common vaginal infections.
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Sherrard J, Donders G, White D, Jensen JS. European (IUSTI/WHO) guideline on the management of vaginal discharge, 2011. Int J STD AIDS 2012; 22:421-9. [PMID: 21795415 DOI: 10.1258/ijsa.2011.011012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Three common infections are associated with vaginal discharge: bacterial vaginosis, trichomoniasis and candidiasis, of which trichomoniasis is a sexually transmitted infection (STI). This guideline covers the presentation and clinical findings of these infections and outlines the differential diagnoses. Recommendations for investigation and management based on currently available evidence are made, including the management of persistent and recurrent infections.
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Affiliation(s)
- J Sherrard
- Department of Genitourinary Medicine, Churchill Hospital, Oxford, UK.
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Nam YH, Min A, Kim SH, Lee YA, Kim KA, Song KJ, Shin MH. Leukotriene B(4) receptors BLT1 and BLT2 are involved in interleukin-8 production in human neutrophils induced by Trichomonas vaginalis-derived secretory products. Inflamm Res 2012; 61:97-102. [PMID: 22215047 DOI: 10.1007/s00011-011-0425-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 10/02/2011] [Accepted: 12/22/2011] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE AND METHOD Trichomonas vaginalis is a flagellated protozoan parasite that causes human trichomoniasis. Although T. vaginalis itself can secrete lipid mediator leukotriene (LT) B(4) leading to neutrophil activation, information regarding the signaling mechanism involved in neutrophil activation induced by T. vaginalis-secreted LTB(4) is limited. We investigated whether LTB(4) contained in the T. vaginalis-derived secretory products (TvSP) is closely involved in interleukin (IL)-8 production in human neutrophils via LTB(4) receptors BLT1 or BLT2. RESULTS T. vaginalis produced more than 714 pg/ml of LTB(4) per 1 × 10(7) trichomonads. The ability of trichomonads to secrete LTB(4) was inhibited by treatment of trichomonads with the 5-lipo-oxygenease inhibitor AA861, but not the cyclo-oxygenease I inhibitor FR122047. When neutrophils were incubated with TvSP obtained from 1 × 10(7) trichomonads, IL-8 protein secretion was significantly increased compared to results for cells incubated with medium alone. The stimulatory effect of TvSP on IL-8 production was strongly inhibited by pretreatment of TvSP with lipase, although pretreatment with heat or proteinase K showed little inhibitory effect. Moreover, TvSP-induced IL-8 production was efficiently inhibited when trichomonads were pretreated with AA861 or when neutrophils were pretreated with antagonists for BLT1 or BLT2. CONCLUSION Our results suggest that LTB(4) receptors BLT1 and BLT2 are involved in IL-8 production in neutrophils induced by T. vaginalis.
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Affiliation(s)
- Young Hee Nam
- Department of Environmental Medical Biology and Institute of Tropical Medicine, Yonsei University College of Medicine, 134 Sichon-dong, Seodaemun-gu, Seoul, 120-752, Korea
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Derbent AU, Ulukanligil M, Keskin EA, Soylu G, Kafali H. Does Vaginal Irrigation with Saline Solution in Women with Infectious Vaginitis Contribute to the Clinical and Microbiological Results of Antibiotic Therapy? Gynecol Obstet Invest 2012; 73:195-200. [DOI: 10.1159/000332396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 08/23/2011] [Indexed: 11/19/2022]
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Bohbot JM, Lepargneur JP. [Bacterial vaginosis in 2011: a lot of questions remain]. ACTA ACUST UNITED AC 2011; 40:31-6. [PMID: 22197267 DOI: 10.1016/j.gyobfe.2011.10.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 09/27/2011] [Indexed: 11/13/2022]
Abstract
Bacterial vaginosis is one of the most frequent vaginal affections. It results from a deep imbalance of the vaginal ecosystem whose mechanisms remain mysterious, even if recent progress were accomplished in their comprehension: if the flora implied in the bacterial vaginosis is recognized like polymorphic, it appears that Gardnerella vaginalis plays a major part with two genomically different forms: a commensal form (slightly adhesive to the epithelial cells), and a pathogenic one (strongly adhesive to the epithelial cells); the changes in lactobacilli are also to take into account: L. iners could be a marker of the vaginal flora imbalance whereas L. crispatus is generally met in the normal vaginal flora. These findings could influence the composition of coming probiotics; it is recognized that bacterial vaginosis is involved in the risk of prematurity but molecular quantification of G. vaginalis (and of Atopobium vaginae) is more sensitive for the diagnosis of BV what could improve the detection of high-risk pregnant women. The isolated antibiotic treatments are not very effective on the prevention of recurrences. The rebalancing of the vaginal flora is essential. In this field, the local estrogens showed some effectiveness. The use of probiotics is promising and can be recommended in complement of the antibiotic treatment even if the results of the clinical studies are still too heterogeneous to lead to precise indications.
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Affiliation(s)
- J-M Bohbot
- Institut Fournier, 25, boulevard Saint-Jacques, 75014 Paris, France.
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Nam YH, Min D, Kim HP, Song KJ, Kim KA, Lee YA, Kim SH, Shin MH. Leukotriene B4 receptor BLT-mediated phosphorylation of NF-κB and CREB is involved in IL-8 production in human mast cells induced by Trichomonas vaginalis-derived secretory products. Microbes Infect 2011; 13:1211-20. [DOI: 10.1016/j.micinf.2011.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 07/01/2011] [Accepted: 07/04/2011] [Indexed: 02/08/2023]
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Abstract
Genital malodor is a common distressing complaint that brings a woman to her physician's office. Vaginal infections, primarily bacterial vaginosis and trichomoniasis, still remain the commonest causes and are relatively easy to diagnose and treat. However, in approximately one third of women who present with malodor, no cause is identified. Although data on the management of vaginal discharge are extensive, the management of genital odor beyond common vaginal infections remains poorly studied. This presents a frustrating situation for both the patient and her physician. Often, patients resort to home remedies and over-the-counter preparations, which, while providing short-term relief for some women, almost never address the cause and, in some cases, can exacerbate symptoms. In this review, we have attempted to consolidate the known and documented causes of genital malodor including the nonvaginal causes and provide case studies that will help clinicians understand the possible settings for the various causes. We also provide an algorithm for the management of this symptom beyond vaginal infections.
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Nam YH, Min D, Park SJ, Kim KA, Lee YA, Shin MH. NF-κB and CREB are involved in IL-8 production of human neutrophils induced by Trichomonas vaginalis-derived secretory products. THE KOREAN JOURNAL OF PARASITOLOGY 2011; 49:291-4. [PMID: 22072831 PMCID: PMC3210848 DOI: 10.3347/kjp.2011.49.3.291] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 07/18/2011] [Accepted: 07/28/2011] [Indexed: 12/17/2022]
Abstract
Trichomonas vaginalis is a flagellated lumen-dwelling extracellular protozoan parasite that causes human trichomoniasis via sexual intercourse. Human neutrophils play a crucial role in acute tissue inflammatory responses in T. vaginalis infection. In this study, we investigated the signaling mechanism of neutrophil responses when stimulated with T. vaginalis-derived secretory products (TvSP), which were collected from 1×107 live trichomonads. Incubation of human neutrophils isolated from peripheral blood with TvSP induced up-regulation of IL-8 protein secretion. In addition, stimulation with TvSP induced phosphorylation of NF-κB and CREB in neutrophils. Moreover, TvSP-induced IL-8 production was also significantly inhibited by pretreatment of neutrophils with iκB inhibitor or CREB inhibitor. These results suggest that transcription factors NF-κB and CREB are involved in IL-8 production in human neutrophils induced by stimulation with T. vaginalis infection.
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Affiliation(s)
- Young Hee Nam
- Department of Environmental Medical Biology, Yonsei University College of Medicine, Seoul 120-752, Korea
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Interobserver Reliability of Microscopic Assessment of Saline-Prepared Vaginal Fluid. J Low Genit Tract Dis 2011; 15:120-3. [DOI: 10.1097/lgt.0b013e3181f68901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gondo F, da Silva MG, Polettini J, Tristao ADR, Peracoli JC, Witkin SS, Rudge MVC. Vaginal flora alterations and clinical symptoms in low-risk pregnant women. Gynecol Obstet Invest 2010; 71:158-62. [PMID: 21160139 DOI: 10.1159/000316051] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 05/31/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND To evaluate associations between alterations in vaginal flora and clinical symptoms in low-risk pregnant women. METHODS Vaginal specimens from 245 pregnant women were analyzed by microscopy for vaginal flora. Signs and symptoms of vaginal infection were determined by patient interviews and gynecologic examinations. RESULTS Abnormal vaginal flora was identified in 45.7% of the subjects. The final clinical diagnoses were bacterial vaginosis (21.6%), vaginal candidosis (10.2%), intermediate vaginal flora (5.2%), aerobic vaginitis (2.9%), mixed flora (2.9%) and other abnormal findings (2.9%). The percentage of women with or without clinical signs or symptoms was not significantly different between these categories. The presence of vaginal odor or vaginal discharge characteristics was not diagnostic of any specific flora alteration; pruritus was highly associated with candidosis (p < 0.0001). Compared to women with normal flora, pruritus was more prevalent in women with candidosis (p < 0.0001), while vaginal odor was associated with bacterial vaginosis (p = 0.0026). CONCLUSION The prevalence of atypical vaginal flora is common in our low-risk pregnant population and is not always associated with pathology. The occurrence of specific signs or symptoms does not always discriminate between women with different types of atypical vaginal flora or between those with abnormal and normal vaginal flora.
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Affiliation(s)
- Fausto Gondo
- Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP-São Paulo State University, Botucatu, Brazil
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Diagnosis and management of bacterial vaginosis and other types of abnormal vaginal bacterial flora: a review. Obstet Gynecol Surv 2010; 65:462-73. [PMID: 20723268 DOI: 10.1097/ogx.0b013e3181e09621] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
UNLABELLED Bacterial vaginosis (BV) is a common cause of abnormal vaginal discharge. It is characterised by an overgrowth of predominantly anaerobic organisms (Gardnerella vaginalis, Prevotella spp., Peptostreptocci, Mobiluncus spp.) in the vagina leading to a replacement of lactobacilli and an increase in vaginal pH. BV can arise and remit spontaneously, but often presents as a chronic or recurrent disease. BV is found most often in women of childbearing age, but may also be encountered in menopausal women, and is rather rare in children. The clinical and microscopic features and diagnosis of BV are herein reviewed, and antibiotic and non-antibiotic treatment approaches discussed. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completion of this educational activity, the participant should be better able to analyze bacterial vaginosis clinically, formulate an oral antibiotic treatment regimen for bacterial vaginosis and use vaginal treatments for bacterial vaginosis.
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Abstract
OBJECTIVE To establish and compare the prevalence of group B streptococcus (GBS) colonization in the vaginas of nonobstetric women with and without vaginitis. MATERIALS AND METHODS Cross-sectional analysis GBS vaginal culture status of nonpregnant, estrogen-replete women 18 years or older presenting for annual gynecological examinations or vaginal infection. Subjects were classified into 3 groups: no vaginitis if symptoms were absent and examination results was normal; common vaginitis (CV) if microscopic examination revealed yeast, bacterial vaginosis, or trichomonads; or inflammatory vaginitis (IV) if examination revealed inflammation and immature squamous cells but no pathogens. RESULTS Of the 215 women recruited, 147 (68.4%) showed no evidence of vaginitis, 41 (19.1%) had CV, and 27 (12.6%) showed evidence of IV. The overall prevalence rate of GBS was 22.8%. Vaginitis was associated with a significantly increased risk of GBS colonization (adjusted odds ratio: CV = 2.7, 95% CI = 1.1-6.2; IV = 2.9, 95% CI = 1.1-8.0). Logistic regression revealed pH higher than 4.5, presence of abnormal discharge on examination, and a women's complaint of current symptoms as significant predicators of the presence of GBS. CONCLUSIONS Group B streptococcus colonization occurs more commonly in women with vaginitis. This suggests that disruption of the normal vaginal bacterial environment is an important predictor for GBS colonization.
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Dai Q, Hu L, Jiang Y, Shi H, Liu J, Zhou W, Shen C, Yang H. An epidemiological survey of bacterial vaginosis, vulvovaginal candidiasis and trichomoniasis in the Tibetan area of Sichuan Province, China. Eur J Obstet Gynecol Reprod Biol 2010; 150:207-9. [DOI: 10.1016/j.ejogrb.2010.02.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 01/25/2010] [Accepted: 02/10/2010] [Indexed: 10/19/2022]
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Esim Buyukbayrak E, Kars B, Karsidag AYK, Karadeniz BI, Kaymaz O, Gencer S, Pirimoglu ZM, Unal O, Turan MC. Diagnosis of vulvovaginitis: comparison of clinical and microbiological diagnosis. Arch Gynecol Obstet 2010; 282:515-9. [PMID: 20461391 DOI: 10.1007/s00404-010-1498-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 04/23/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of the present study was to compare the current diagnostic clinical and laboratory approaches to women with vulvovaginal discharge complaint. The secondary outcomes were to determine the prevalence of infections in our setting and to look for the relation between vulvovaginal infections and predisposing factors if present. METHOD Premenopausal women applying to our gynecology outpatient clinic with vaginal discharge complaint were enrolled prospectively into the study. Each patient evaluated clinically with direct observation of vaginal secretions, wet mount examination, whiff test, vaginal pH testing and chlamydia rapid antigen test. Each patient also evaluated microbiologically with vaginal discharge culture and gram staining. Clinical diagnosis was compared with the microbiological diagnosis (the gold standard). Diagnostic accuracy was measured with sensitivity, specificity, positive (ppv) and negative predictive values (npv). RESULTS 460 patients were included in the study. 89.8% of patients received a clinical diagnosis whereas only 36% of them had microbiological diagnosis. The sensitivity, specificity, ppv, npv of clinical diagnosis over microbiological culture results were 95, 13, 38, 82%, respectively. The most commonly encountered microorganisms by culture were Candida species (17.4%) and Gardnerella vaginalis (10.2%). Clinically, the most commonly made diagnoses were mixed infection (34.1%), bacterial vaginosis (32.4%) and fungal infection (14.1%). Symptoms did not predict laboratory results. Predisposing factors (DM, vaginal douching practice, presence of IUD and usage of oral contraceptive pills) were not found to be statistically important influencing factors for vaginal infections. CONCLUSION Clinical diagnosis based on combining symptoms with office-based testing improves diagnostic accuracy but is insufficient. The most effective approach also incorporates laboratory testing as an adjunct when a diagnosis is in question or treatment is failing.
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Affiliation(s)
- Esra Esim Buyukbayrak
- Department of Gynecology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Kartal, Istanbul, Turkey.
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Abstract
PURPOSE OF REVIEW Trichomoniasis, caused by the protozoa Trichomonas vaginalis, is one of the oldest sexually transmitted infections. Since the advent of more accurate diagnostic tests, the epidemiology and consequences of infection with T. vaginalis can be described more precisely. This review will highlight new diagnostic methods, the epidemiology of trichomoniasis, and discuss the merits of improved screening for this pathogen in adolescent women. RECENT FINDINGS Interest in trichomoniasis has renewed due to evidence that trichomoniasis is more common than gonorrhea in adolescent women, is often asymptomatic, may persist for several months, and may be confused with bacterial vaginosis. In addition, trichomoniasis is linked to pelvic inflammatory disease and can increase one's susceptibility to viruses such as herpes, human papillomavirus, andHIV. SUMMARY Clinicians who use better diagnostic methods and offer more widespread testing will identify more infections and reduce the epidemic of this easily treated infection. Early diagnosis provides the opportunity to reduce transmission and potentially prevent future complications.
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Sobel JD, Nyirjesy P, Kessary H, Ferris DG. Use of the VS-sense swab in diagnosing vulvovaginitis. J Womens Health (Larchmt) 2009; 18:1467-70. [PMID: 19743911 DOI: 10.1089/jwh.2008.1305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although pH assessment of vaginal secretions is beneficial for diagnosing vaginitis, it is not commonly done. The purpose of this study was to determine the performance characteristics of the VS-Sense (pH test) swab (Common Sense, Ltd., Caesarea, Israel) in augmenting the diagnosis of vaginitis. METHODS We prospectively studied 193 women with acute vulvovaginal symptoms and 74 asymptomatic controls at three medical centers. The VS-Sense swab was administered intravaginally, and results were interpreted by a nurse. These results were compared with final clinical and laboratory diagnoses. RESULTS In women with an elevated pH caused by bacterial vaginosis (BV), trichomonas, and other types of vaginitis, the VS-Sense test sensitivity and specificity were 82.3% (102 of 124) (95% CI 74.4%-88.5%) and 94.2% (129 of 137) (95% CI 88.8%-97.4%), respectively. There was an 86.2% (95% CI 81.3%-90.1%) overall agreement between pH paper and VS-Sense swab results. CONCLUSIONS The VS-Sense test offers an alternative approach to measuring vaginal pH with nitrazine paper. Use of this simple, more rapid test may facilitate the diagnosis of vulvovaginitis.
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Affiliation(s)
- Jack D Sobel
- Department of Internal Medicine, Wayne State University, Detroit, Michigan, USA
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Abstract
Many women seek care for vulvar, vaginal, or pelvic complaints. Primary care providers should possess a solid understanding of the differential diagnosis and treatment of gynecologic infections. Many infections in the reproductive tract are sexually transmitted, whereas other common infections are attributable to an overgrowth of the normally present bacteria or yeast in the vagina. Presenting symptoms and signs are helpful in determining the source of infection, but often a battery of tests must be performed to make a definitive diagnosis.
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MESH Headings
- Anti-Bacterial Agents/therapeutic use
- Antifungal Agents/therapeutic use
- Antiviral Agents/therapeutic use
- Candidiasis, Vulvovaginal/diagnosis
- Candidiasis, Vulvovaginal/drug therapy
- Candidiasis, Vulvovaginal/microbiology
- Chlamydia Infections/diagnosis
- Chlamydia Infections/drug therapy
- Diagnosis, Differential
- Female
- Genital Diseases, Female/diagnosis
- Genital Diseases, Female/drug therapy
- Genital Diseases, Female/microbiology
- Gonorrhea/diagnosis
- Gonorrhea/drug therapy
- Herpes Genitalis/diagnosis
- Herpes Genitalis/drug therapy
- Humans
- Pelvic Inflammatory Disease/diagnosis
- Pelvic Inflammatory Disease/drug therapy
- Pelvic Inflammatory Disease/microbiology
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/drug therapy
- Syphilis/diagnosis
- Syphilis/drug therapy
- Trichomonas Vaginitis/diagnosis
- Trichomonas Vaginitis/drug therapy
- Vaginosis, Bacterial/diagnosis
- Vaginosis, Bacterial/drug therapy
- Vaginosis, Bacterial/microbiology
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Affiliation(s)
- Wendy S Biggs
- Department of Family Medicine, Michigan State University College of Human Medicine, East Lansing, MI, USA.
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Efficient diagnosis of vulvovaginal candidiasis by use of a new rapid immunochromatography test. J Clin Microbiol 2009; 47:3821-5. [PMID: 19794036 DOI: 10.1128/jcm.01168-09] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The clinical symptoms of vulvovaginal candidiasis (VVC) are nonspecific, and misdiagnosis is common, leading to a delay in the initiation of antifungal treatment. We evaluated a new immunochromatography test (ICT), the CandiVagi assay (SR2B, Avrille, France), for the rapid diagnosis of VVC. This test, which employs an immunoglobulin M antibody directed against the beta-1,2-mannopyranosyl epitopes found in the yeast cell wall, was compared with direct microscopic examination and culture of vaginal swabs. Two-hundred five women were investigated, including 130 women with symptomatic vaginitis and 75 asymptomatic controls. Two vaginal swabs were obtained from each woman: one was used to prepare a wet mount and Gram-stained preparations for direct microscopic examination and was also cultured on Sabouraud dextrose agar for the isolation of Candida spp., and the second swab was used for ICT. The sensitivities of microscopic examination, culture, and ICT for the diagnosis of VVC were 61%, 100%, and 96.6%, respectively, while the specificities of the three methods were 100%, 82%, and 98.6%, respectively. ICT had a negative predictive value of 98.6%, a positive predictive value of 96.6%, and an efficiency of 98%. ICT provided a rapid result and a better compromise between sensitivity and specificity than conventional microscopy and culture for the diagnosis of VVC. This easy-to-perform diagnostic test will be useful to practitioners treating women with symptoms of vaginitis.
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Nguyễn MH, Gammeltoft T, Christoffersen SV, Trần TT, Rasch V. Reproductive Tract Infections in Northern Vietnam: Health Providers' Diagnostic Dilemmas. Women Health 2009; 49:229-45. [DOI: 10.1080/03630240902963630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- M[ytilde] Hu'o'ng Nguyễn
- a Institute for Population and Development Studies, General Office for Population and Family Planning, Ministry of Health , Hanoi, Vietnam
| | - Tine Gammeltoft
- b Department of Anthropology , University of Copenhagen , Copenhagen, Denmark
| | - Sarah Vigh Christoffersen
- c Department of International Health , Immunology & Microbiology, University of Copenhagen , Copenhagen, Denmark
| | - Thu Thuỷ Trần
- d Office for Population and Family Planning , Hai Phong, Vietnam
| | - Vibeke Rasch
- c Department of International Health , Immunology & Microbiology, University of Copenhagen , Copenhagen, Denmark
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Kisa S, Taskin L. Validity of the symptomatic approach used by nurses in diagnosing vaginal infections. J Clin Nurs 2009; 18:1059-68. [DOI: 10.1111/j.1365-2702.2008.02702.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lowe NK, Neal JL, Ryan-Wenger NA. Accuracy of the clinical diagnosis of vaginitis compared with a DNA probe laboratory standard. Obstet Gynecol 2009; 113:89-95. [PMID: 19104364 PMCID: PMC2745984 DOI: 10.1097/aog.0b013e3181909f63] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the accuracy of the clinical diagnosis of the three most common causes of acute vulvovaginal symptoms (bacterial vaginosis, candidiasis vaginitis, and trichomoniasis vaginalis) using a traditional, standardized clinical diagnostic protocol compared with a DNA probe laboratory standard. METHODS This prospective clinical comparative study had a sample of 535 active-duty United States military women presenting with vulvovaginal symptoms. Clinical diagnoses were made by research staff using a standardized protocol of history, physical examination including pelvic examination, determination of vaginal pH, vaginal fluid amines test, and wet-prep microscopy. Vaginal fluid samples were obtained for DNA analysis. The research clinicians were blinded to the DNA results. RESULTS The participants described a presenting symptom of abnormal discharge (50%), itching/irritation (33%), malodor (10%), burning (4%), or others such as vulvar pain and vaginal discomfort. According to laboratory standard, there were 225 cases (42%) of bacterial vaginosis, 76 cases (14%) of candidiasis vaginitis, 8 cases (1.5%) of trichomoniasis vaginalis, 87 cases of mixed infections (16%), and 139 negative cases (26%). For each single infection, the clinical diagnosis had a sensitivity and specificity of 80.8% and 70.0% for bacterial vaginosis, 83.8% and 84.8% for candidiasis vaginitis, and 84.6% and 99.6% for trichomoniasis vaginalis when compared with the DNA probe standard. CONCLUSION Compared with a DNA probe standard, clinical diagnosis is 81-85% sensitive and 70-99% specific for bacterial vaginosis, Candida vaginitis, and trichomoniasis. Even under research conditions that provided clinicians with sufficient time and materials to conduct a thorough and standardized clinical evaluation, the diagnosis and, therefore, subsequent treatment of these common vaginal problems remains difficult. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Nancy K Lowe
- From the Division of Women, Children and Family Health, University of Colorado Denver College of Nursing, Aurora, Colorado; and Ohio State University College of Nursing, Columbus, Ohio
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76
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77
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Engberts MK, Korporaal H, Vinkers M, van Belkum A, van Binsbergen J, Lagro-Janssen T, Helmerhorst T, van der Meijden W. Vulvovaginal candidiasis: diagnostic and therapeutic approaches used by Dutch general practitioners. Eur J Gen Pract 2008; 14:30-3. [PMID: 18464170 DOI: 10.1080/13814780701814929] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To establish how general practitioners (GPs) in the Netherlands diagnose and treat vaginal candidiasis. METHODS Questionnaires were sent to 1160 Dutch GPs. The GPs were asked to make an inventory of the annual number of consultations for vulvovaginal candidiasis. Furthermore, information was requested with regard to diagnostic examinations performed and preferred treatment when dealing with vulvovaginal candidiasis. RESULTS 380 (32.87%) GPs returned the questionnaire, of which 189 GPs worked in single-person practices (n=189). The group of 380 GPs consisted of 269 (70.8%) males and 111 (29.2%) females. On average, GPs reported 105.6 consultations concerning vaginal candidiasis per practice per year. Only 61 (16.1%) Dutch GPs always or often performed microscopy when diagnosing candidiasis, while 143 (37.6%) GPs never used a microscope to confirm their diagnosis. Furthermore, only 30 (7.9%) GPs regularly took Candida cultures, whereas 154 GPs (40.5%) never took a vaginal swab to diagnose acute candidiasis. Treatment of choice was mostly miconazole (50%) or clotrimazole (24%). CONCLUSION GPs often diagnose "vulvovaginal candidiasis" in their practices, but often do not perform the laboratory examinations required to confirm their putative diagnosis. This may lead to wrong diagnoses and maltreatment with antimycotics, without cure of the patients' vaginal complaints.
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78
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Mycoplasma genitalium detected by transcription-mediated amplification is associated with Chlamydia trachomatis in adolescent women. Sex Transm Dis 2008; 35:250-4. [PMID: 18490867 DOI: 10.1097/olq.0b013e31815abac6] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The clinical significance of Mycoplasma genitalium (MG) infection in adolescent women is poorly understood. We compared the prevalence of MG with that of other sexually transmitted organisms such as Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) and assessed the associations of MG with sexual behaviors, genitourinary symptoms, physical and laboratory findings. STUDY DESIGN Women aged 14 to 21 years (n = 331) were recruited from an urban medical center. The subjects' sexual behaviors, genitourinary symptoms, and physical findings were recorded. Endocervical swabs were collected for CT and NG testing and vaginal swabs for wet mount, Gram stain, TV and MG testing. MG infection was identified by nucleic acid amplification using a transcription-mediated amplification assay. RESULTS MG was detected in 74 (22.4%), CT in 79 (24.4%), TV in 60 (18.2%), and NG in 35 (10.7%) subjects. MG infection was not associated with vaginal symptoms, physical evidence of cervicitis, or findings on wet mount or Gram stain. In logistic regression, variables positively associated with MG were current CT [odds ratio (OR), 2.3; 95% confidence interval (CI), 1.4-4.4] and recent sexual contact (< or =7 days) (OR, 2.0; CI, 1.1-3.2). Dysuria (OR, 0.44; CI, 0.2-0.96) and use of hormonal contraception (OR, 0.55; CI, 0.3-1.0) were negatively associated with MG infection. CONCLUSION In adolescent women, MG infection was as common as chlamydial infection and trichomoniasis and more common than gonorrhea. MG was associated with CT and recent sexual contact but not with vaginal symptoms or signs of cervicitis.
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79
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Efficacy and tolerance of metronidazole and miconazole nitrate in treatment of vaginitis. Int J Gynaecol Obstet 2008; 102:287-92. [PMID: 18603245 DOI: 10.1016/j.ijgo.2008.04.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Revised: 04/09/2008] [Accepted: 04/10/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the efficacy and tolerability of a vaginal pessary containing 750 mg of metronidazole and 200 mg of miconazole nitrate used daily for 7 days in the treatment of vaginitis. METHODS Ninety-two women with vaginitis participated in this phase 3 study using one vaginal pessary daily for 7 days. Gynecological and microbiological evaluations were carried out prior to and following treatment. RESULTS Reductions occurred in symptoms and signs of vaginitis. Clinical cure rate was 87.7%, while the cure rates according to microscopy and Candida albicans culture were 81.8% and 73.9%, respectively. The cure rate for bacterial vaginosis was 75% and culture of Gardnerella vaginalis turned negative in 63.6% of cases following treatment. The medication was well tolerated. CONCLUSION Use of a combination of 750 mg of metronidazole and 200 mg of miconazole in a single daily application was found to be effective in the treatment of the most common causes of vaginitis.
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80
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Chesson HW, Collins D, Koski K. Formulas for estimating the costs averted by sexually transmitted infection (STI) prevention programs in the United States. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2008; 6:10. [PMID: 18500996 PMCID: PMC2426671 DOI: 10.1186/1478-7547-6-10] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Accepted: 05/23/2008] [Indexed: 01/30/2023] Open
Abstract
Background Sexually transmitted infection (STI) prevention programs can mitigate the health and economic burden of STIs. A tool to estimate the economic benefits of STI programs could prove useful to STI program personnel. Methods We developed formulas that can be applied to estimate the direct medical costs and indirect costs (lost productivity) averted by STI programs in the United States. Costs and probabilities for these formulas were based primarily on published studies. Results We present a series of formulas that can be used to estimate the economic benefits of STI prevention (in 2006 US dollars), using data routinely collected by STI programs. For example, the averted sequelae costs associated with treating women for chlamydia is given as (Cw)(0.16)(0.925)(0.70)($1,995), where Cw is the number of infected women treated for chlamydia, 0.16 is the absolute reduction in the probability of pelvic inflammatory disease (PID) as a result of treatment, 0.925 is an adjustment factor to prevent double-counting of PID averted in women with both chlamydia and gonorrhea, 0.70 is an adjustment factor to account for the possibility of re-infection, and $1,995 is the average cost per case of PID, based on published sources. Conclusion The formulas developed in this study can be a useful tool for STI program personnel to generate evidence-based estimates of the economic impact of their program and can facilitate the assessment of the cost-effectiveness of their activities.
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Affiliation(s)
- Harrell W Chesson
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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81
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Chase PB, Hansen KL, Rothers J, Biros MH, Cartwright CP. Nucleic-acid amplification testing of urine vs. patient complaint-driven evaluation. J Emerg Med 2008; 38:572-7. [PMID: 18462909 DOI: 10.1016/j.jemermed.2007.10.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Revised: 07/12/2007] [Accepted: 10/30/2007] [Indexed: 10/22/2022]
Abstract
The present pilot study compared the ability of a conventional patient complaint-driven approach to that of nucleic-acid amplification testing (NAAT) of urine to identify those individuals among an adult, urban, Emergency Department (ED) population infected with Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV). Urine for NAAT was collected for testing after individuals had completed a questionnaire and before being seen by a physician. A total of 614 subjects were enrolled, and complete physical examinations were performed on 348 (56.6%) individuals, with women being significantly more likely to receive such an evaluation (odds ratio [OR] 3.09; 95% confidence interval [CI] 1.96-4.86); p < 0.001). A total of 153 (24.9%) of the study cohort tested positive for a least one sexually transmitted disease (STD), and only a reported history of STD (OR 1.74; 95% CI (1.18-2.57); p = 0.005) and a history of a new sexual partner in the last 3 months (OR 1.79; 95% CI 1.13-2.82); p = 0.012) were predictive of a positive STD test. NAAT of urine samples on patients who did not receive a complete physical examination resulted in a 33% (51/153) increase in diagnostic yield in this cohort of ED attendees.
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Affiliation(s)
- Peter B Chase
- Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona 85724-5057, USA
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82
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Liu XP, Fan SR. Methylrosaniline chloride stained vaginal smears for the diagnosis of vulvovaginal candidiasis. Int J Gynaecol Obstet 2007; 99:83-6. [PMID: 17904142 DOI: 10.1016/j.ijgo.2007.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Revised: 05/30/2007] [Accepted: 06/04/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the sensitivity and specificity of methylrosaniline chloride stained vaginal smears for the diagnosis of vulvovaginal candidiasis (VVC). METHOD Between September 2005 and February 2006, 214 cases of patients with VVC and 102 cases of controls were investigated at Peking University Shenzhen Hospital. All strains were identified with the API Candida system. RESULTS The average age of the patients was 29.87 years. The sensitivity and specificity of methylrosaniline chloride stained vaginal smears for the diagnosis of vulvovaginal candidiasis were 88.3% (189/214) and 96.1 (98/102). The sensitivity of the vaginal smears for the diagnosis of recurrent vulvovaginal candidiasis, mild vulvovaginal candidiasis and severe vulvovaginal candidiasis were 85.2% (46/54), 74.7% (71/95) and 99.2% (118/119). CONCLUSION Methylrosaniline chloride stained vaginal smears for the diagnosis of vulvovaginal candidiasis are reliable and inexpensive.
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Affiliation(s)
- X P Liu
- Department of Laboratory Science, Peking University Shenzhen Hospital, Shenzhen, China
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83
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Abstract
Despite therapeutic advances, vulvovaginal candidosis remains a common problem worldwide, affecting all strata of society. Understanding of anti-candida host defence mechanisms in the vagina has developed slowly and, despite a growing list of recognised risk factors, a fundamental grasp of pathogenic mechanisms continues to elude us. The absence of rapid, simple, and inexpensive diagnostic tests continues to result in both overdiagnosis and underdiagnosis of vulvovaginal candidosis. I review the epidemiology and pathogenesis of this infection, and also discuss management strategies.
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Affiliation(s)
- Jack D Sobel
- Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
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84
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Zhou X, Brown CJ, Abdo Z, Davis CC, Hansmann MA, Joyce P, Foster JA, Forney LJ. Differences in the composition of vaginal microbial communities found in healthy Caucasian and black women. ISME JOURNAL 2007; 1:121-33. [PMID: 18043622 DOI: 10.1038/ismej.2007.12] [Citation(s) in RCA: 375] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The maintenance of a low pH in the vagina through the microbial production of lactic acid is known to be an important defense against infectious disease in reproductive age women. Previous studies have shown that this is largely accomplished through the metabolism of lactic acid bacteria, primarily species of Lactobacillus. Despite the importance of this defense mechanism to women's health, differences in the species composition of vaginal bacterial communities among women have not been well defined, nor is it known if and how these differences might be linked to differences in the risk of infection. In this study, we defined and compared the species composition of vaginal bacterial communities in 144 Caucasian and black women in North America. This was carried out based on the profiles of terminal restriction fragments of 16S rRNA genes, and phylogenetic analysis of 16S rRNA gene sequences of the numerically dominant microbial populations. Among all the women sampled, there were eight major kinds of vaginal communities ('supergroups') that occurred in the general populace at a frequency of at least 0.05 (P=0.99). From the distribution of these supergroups among women, it was possible to draw several conclusions. First, there were striking, statistically significant differences (P=0.0) in the rank abundance of community types among women in these racial groups. Second, the incidence of vaginal communities in which lactobacilli were not dominant was higher in black women (33%) as compared to Caucasian women (7%). Communities not dominated by lactobacilli had Atopobium and a diverse array of phylotypes from the order Clostridiales. Third, communities dominated by roughly equal numbers of more than one species of Lactobacillus were rare in black women, but common in Caucasian women. We postulate that because of these differences in composition, not all vaginal communities are equally resilient, and that differences in the vaginal microbiota of Caucasian and black women may at least partly account for known disparities in the susceptibility of women in these racial groups to bacterial vaginosis and sexually transmitted diseases.
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Affiliation(s)
- Xia Zhou
- Department of Biological Sciences, University of Idaho, Moscow, ID 83844, USA
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85
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Abstract
Women often seek medical care for vaginal complaints. Many times, the cause of the complaint is misdiagnosed by the woman and/or her provider. These vaginal complaints may be related to infections, which when misdiagnosed or mistreated, can lead to more severe problems. This article describes the three most common vaginal infections, bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis. Appropriate diagnostic techniques and management therapies are reviewed.
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86
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Bornstein J, Zarfati D. A Universal Combination Treatment for Vaginitis. Gynecol Obstet Invest 2006; 65:195-200. [DOI: 10.1159/000111946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 06/15/2007] [Indexed: 11/19/2022]
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87
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Verbruggen BSM, Boon ME, Melkerl P, van Haaften M, Heintz APM. Microscopic diagnosis of dysbacteriosis in stained vaginal smears in clinical practice. Diagn Cytopathol 2006; 34:686-91. [PMID: 16955476 DOI: 10.1002/dc.20530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Dysbacteriosis is a microscopical diagnosis. In women with dysbacteriosis, an overgrowth of coccoid bacteria and almost a complete absence of lactobacilli are observed in the (stained) vaginal smear. The aim of this study was to determine the accuracy of this microscopic diagnosis in clinical practice. The analysis concerned 342 consecutive cases in which the microscopy of the stained smears was performed by general practitioners trained in diagnosing dysbacteriosis. These smears were sent to the pathologist for confirmation of the microscopical diagnosis of the clinician. The cytological diagnoses of the pathologist, sometimes performed on restained slides when the quality of the staining was substandard, were considered as the "gold standard." In 92 of the 342 cases, dysbacteriosis was unequivocally established by the pathologist. Sensitivity and specificity of the microscopical diagnoses of the clinicians were 40% and 85%, respectively. There were 37 false-positive and 54 false-negative diagnoses of dysbacteriosis rendered by the clinicians. The most frequent reason for a false-negative diagnosis was an excess of lactobacilli in the smear. This study shows that even in stained smears it is difficult for clinicians to render a correct evaluation of the status of the vaginal flora.
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88
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Abstract
STI are among the most common pathological conditions affecting sexually active adolescents. Both screening of asymptomatic adolescents and a thoughtful, thorough approach to the evaluation of symptoms are critical measures in STI identification and control.
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Affiliation(s)
- Cynthia Holland-Hall
- Department of Pediatrics, The Ohio State University College of Medicine and Public Health, Children's Hospital, 700 Children's Drive, Columbus, 43205, USA.
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89
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Hilmarsdóttir I, Hauksdóttir GS, Jóhannesdóttir JD, Daníelsdóttir T, Thorsteinsdóttir H, Olafsson JH. Evaluation of a rapid Gram stain interpretation method for diagnosis of bacterial vaginosis. J Clin Microbiol 2006; 44:1139-40. [PMID: 16517914 PMCID: PMC1393104 DOI: 10.1128/jcm.44.3.1139-1140.2006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A simple Gram stain evaluation for the diagnosis of bacterial vaginosis was assessed in comparison to Nugent's method. The sensitivity (90%), specificity (94%), positive and negative predictive values (90% and 94%), and good interobserver agreement obtained indicate that the test method can be performed reliably in the routine clinical microbiology laboratory.
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Affiliation(s)
- I Hilmarsdóttir
- Department of Microbiology, Landspítali University Hospital, Barónsstígur, 101 Reykjavík, Iceland.
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90
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Abstract
Trichomonas vaginalis has long been recognized as a cause of infectious vaginitis in women. More recently, studies have demonstrated a significant burden of disease in men with urethritis or men at high risk for sexually transmitted diseases. There is increasing interest in this pathogen as more data accumulates linking it to HIV transmission and perinatal morbidity. New diagnostic methods have emerged that may increase sensitivity of diagnosis or improve point-of-care access to testing. Nitroimidazoles remain the mainstay of therapy. Metronidazole and tinidazole are highly effective as single-dose therapy. Unfortunately, despite the link between T. vaginalis infection and perinatal morbidity, nitroimidazole therapy during pregnancy remains controversial. Although metronidazole resistance is currently uncommon, pharmacological features and nitroimidazole resistance patterns suggest that tinidazole may be more effective in treating patients with metronidazole treatment failure. Alternatives to nitroimidazole therapy are few, and most have limited efficacy and significant toxicity.
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Affiliation(s)
- Neha Nanda
- Department of Medicine, Oklahoma University Health Science Center, Oklahoma City, OK, USA
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91
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Schwiertz A, Taras D, Rusch K, Rusch V. Throwing the dice for the diagnosis of vaginal complaints? Ann Clin Microbiol Antimicrob 2006; 5:4. [PMID: 16503990 PMCID: PMC1395331 DOI: 10.1186/1476-0711-5-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Accepted: 02/17/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaginitis is among the most common conditions women are seeking medical care for. Although these infections can easily be treated, the relapse rate is high. This may be due to inadequate use of the diagnostic potential. METHODS We evaluated the misjudgement rate of the aetiology of vaginal complaints. A total of 220 vaginal samples from women with a vaginal complaint were obtained and analysed for numbers of total lactobacilli, H2O2-producing lactobacilli, total aerobic cell counts and total anaerobic cell counts including bifidobacteria, Bacteroides spp., Prevotella spp. Additionally, the presence of Atopobium vaginae, Gardnerella vaginalis, Candida spp. and Trichomonas vaginalis was evaluated by DNA-hybridisation using the PCR and Affirm VPIII Microbial Identification Test, respectively. RESULTS The participating physicians diagnosed Bacterial vaginosis (BV) as origin of discomfort in 80 cases, candidiasis in 109 cases and mixed infections in 8 cases. However, a present BV, defined as lack of H2O2-lactobacilli, presence of marker organisms, such as G. vaginalis, Bacteroides spp. or Atopobium vaginae, and an elevated pH were identified in only 45 cases of the women examined. Candida spp. were detected in 46 cases. Interestingly, an elevated pH corresponded solely to the presence of Atopobium vaginae, which was detected in 11 cases. CONCLUSION Errors in the diagnosis of BV and candida vulvovaginitis (CV) were high. Interestingly, the cases of misjudgement of CV (77%) were more numerous than that of BV (61%). The use of Amsel criteria or microscopy did not reduce the number of misinterpretations. The study reveals that the misdiagnosis of vaginal complaints is rather high.
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Affiliation(s)
| | - David Taras
- Institute of Animal Nutrition, Faculty of Veterinary Medicine, Free University Berlin, Germany
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92
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Nyirjesy P, Sobel JD. Advances in diagnosing vaginitis: development of a new algorithm. Curr Infect Dis Rep 2006; 7:458-62. [PMID: 16225784 DOI: 10.1007/s11908-005-0048-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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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Affiliation(s)
- Paul Nyirjesy
- Department of Obstetrics and Gynecology, Drexel University College of Medicine, 245 North 15th Street, 16th Floor New College Building, Philadelphia, PA 19102, USA.
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93
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Nelson AL. Introduction to Sexually Transmitted Infections. Sex Transm Dis 2006. [DOI: 10.1007/978-1-59745-040-9_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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94
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Karaer A, Boylu M, Avsar AF. Vaginitis in Turkish women: symptoms, epidemiologic - microbiologic association. Eur J Obstet Gynecol Reprod Biol 2005; 121:211-5. [PMID: 16054964 DOI: 10.1016/j.ejogrb.2004.11.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2004] [Revised: 10/22/2004] [Accepted: 11/30/2004] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the relationship between clinical-epidemiologic findings and microbiologic results in vaginitis. METHODS A prospective study of 212 women with vaginal symptoms was undertaken. Each patient underwent an evaluation that included standardized history, interview after pelvic examination and vaginal culture. RESULTS Only 45% of patients received diagnosis. Only two symptoms were more frequently noted with diagnosis. Itching was more frequent in vulvovaginal candidiasis (VCC) whereas odor was more frequent in Bacterial vaginosis (BV). BV was associated with a history of spontaneous and induced abortion, increased number of pregnancy, vaginal douching practice and intrauterine contraceptive device usage. VVC was found to be associated with no contraceptive usage and previous vaginitis history. CONCLUSION Presenting symptoms alone or with microbiologic studies has limited value, and that of the women with vaginal symptoms may lack a microbiologic diagnosis. Evidence-based approaches that produce highly accurate diagnostic and effective treatment regimens would be expected in the future.
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Affiliation(s)
- A Karaer
- Dr. Zekai Tahir Burak Woman Health Education and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
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95
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Carr PL, Rothberg MB, Friedman RH, Felsenstein D, Pliskin JS. "Shotgun" versus sequential testing. Cost-effectiveness of diagnostic strategies for vaginitis. J Gen Intern Med 2005; 20:793-9. [PMID: 16117745 PMCID: PMC1490200 DOI: 10.1111/j.1525-1497.2005.0188.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Revised: 04/26/2005] [Accepted: 05/03/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although vaginitis is a common outpatient problem, only 60% of patients can be diagnosed at the initial office visit of a primary care provider using the office procedures of pH testing, whiff tests, normal saline, and potassium hydroxide preps. OBJECTIVE To determine the most cost-effective diagnostic and treatment approach for the medical management of vaginitis. DESIGN Decision and cost-effectiveness analyses. PARTICIPANTS Healthy women with symptoms of vaginitis undiagnosed after an initial pelvic exam, wet mount preparations, pH, and the four criteria to diagnose bacterial vaginosis. SETTING General office practice. METHODS We evaluated 28 diagnostic strategies comprised of combinations of pH testing, vaginal cultures for yeast and Trichomonas vaginalis, Gram's stain for bacterial vaginosis, and DNA probes for Neisseria gonorrhoeae and Chlamydia. Data sources for the study were confined to English language literature. MEASUREMENT The outcome measures were symptom-days and costs. RESULTS The least expensive strategy was to perform yeast culture, gonorrhoeae and Chlamydia probes at the initial visit, and Gram's stain and Trichomonas culture only when the vaginal pH exceeded 4.9 (330 dollars, 7.30 symptom days). Other strategies cost 8 dollars to 76 dollars more and increased duration of symptoms by up to 1.3 days. In probabilistic sensitivity analysis, this strategy was always the most effective strategy and was also least expensive 58% of the time. CONCLUSIONS For patients with vaginitis symptoms undiagnosed by pelvic examination, wet mount preparations and related office tests, a comprehensive, pH-guided testing strategy at the initial office visit is less expensive and more effective than ordering tests sequentially.
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Affiliation(s)
- Phyllis L Carr
- Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA.
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96
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Henn EW, Kruger TF, Siebert TI. Vaginal discharge reviewed: the adult pre-menopausal female. S Afr Fam Pract (2004) 2005. [DOI: 10.1080/20786204.2005.10873183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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