Increased diagnostic yield of routine multiplex PCR compared to clinician requested testing for detection of Trichomonas vaginalis

Diagnosis and treatment of infectious vaginitis: Proposal for a new algorithm

Background

Vaginitis is the most common gynecologic diagnosis in primary care, and most women have at least one episode during their lives. The need for standardized strategies to diagnose and treat vaginitis, both in primary care and among gynecologists, is emphasized. The Brazilian Group for Vaginal Infections (GBIV, acronym in Portuguese) aimed to update the practical approach to affected women by reviewing and discussing recent literature, and developing algorithms for diagnosis and treatment of vaginitis.

Methods

A literature search within biomedical databases PubMed and SCieLo was conducted in January 2022. The available literature was evaluated by three experienced researchers, members of the GBIV, to summarize the main data and develop practical algorithms.

Results and conclusion

Detailed algorithms were developed with the main goal to improve gynecological practice considering different scenarios and access to diagnostic tools, from the simplest to the most complex tests. Different age groups and specific contexts were also considered. The combination of anamnesis, gynecological examination, and complementary tests remains the basis of a proper diagnostic and therapeutic approach. Periodic updates of these algorithms are warranted as new evidence becomes available.

Medical Appropriateness and Economics of Nucleic Acid Amplification Testing for Infectious Diseases

It has become commonplace to assume that nucleic acid amplification tests (NAATs) represent the gold standard for all infectious disease diagnostic testing. This proposition has become increasingly entrenched recently, as these tests can now be done, in comparison to even just a few years ago, relatively inexpensively and with rapid analytic turnaround times. Many can even be performed at the Point-of-Care by individuals without technical backgrounds. But there may be a dark underside to this proposition. Could these tests be too sensitive? Are they always "fit for purpose"? Should they trump clinical judgement? Do they have untoward impacts on antimicrobial therapy? Could the profit motive - by manufacturers and by laboratories - be fueling the explosive expansion of NAATs? In this article, we will explore these questions in regard to several specific NAAT examples - Group A Streptococcus, Influenza, SARS-CoV-2, respiratory panels, and sexually transmitted disease panels.