Medical Education Library

New Approaches to the Diagnosis of Vaginitis

This supplement is sponsored by Quest Diagnostics
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Genital tract infections (GTIs) are highly prevalent and most women will have a vaginal infection during their lifetime.1 Specifically, approximately 75% of women will have at least 1 episode of vulvovaginal candidiasis (VVC) and more than 2.3 million women in the United States will contract a trichomoniasis infection. It is estimated that 29% of women in the United States have bacterial vaginosis (BV).2 Given the scope of vaginitis prevalence, it is vital that clinicians have access to the most sensitive and specific diagnostic tools.

Effective treatment of vaginitis is highly dependent on the clinician’s ability to make an accurate diagnosis. Signs and symptoms alone do not provide a precise diagnosis; therefore, clinicians will typically utilize laboratory tests to determine the exact nature of the vaginal infection.

Vaginal infections have traditionally been diagnosed using a combination of gynecologic examination, vaginal pH, microscopic evaluation of Gram stain and/or wet mount, and an amine odor test. However, most clinicians do not have access
to microscopy and as a result empiric diagnoses are common and lead to incorrect treatment and management.3

Nucleic acid amplification testing (NAAT) has been the mainstay of diagnosis for gonorrhea and chlamydia for several years. This testing platform results in high sensitivity and specificity and has rendered culture-based testing for these infections all but obsolete.4 Table 1 illustrates the sensitivity and specificity of a nucleic acid probe assay relative to 2 reference methods (microscopy and culture).

Nucleic acid amplification tests are designed to target the microorganisms that are most likely causing vaginal symptoms. Targeted testing is the most clinically appropriate testing choice for women with high-risk histories or symptoms as shown in Table 2.

This supplement will address some of the more prevalent GTIs that may develop in women. While many of the following infections are associated with signs and symptoms, affected patients are just as often asymptomatic. Moreover, many signs and symptoms of some GTIs can overlap those of other GTIs, confounding diagnosis based simply on signs and symptoms.

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