Diagnosis and Treatment of Vaginal Discharge Syndromes in Community Practice Settings

Sharon L Hillier, Michele Austin, Ingrid Macio, Leslie A Meyn, David Badway, Richard Beigi, Sharon L Hillier, Michele Austin, Ingrid Macio, Leslie A Meyn, David Badway, Richard Beigi

Abstract

Background: Although vaginal symptoms are common, diagnosis of bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and Trichomonas vaginalis (TV) is not standardized. Diagnostic approaches and appropriateness of treatment were evaluated for women with symptoms of vaginitis who were seeking care at community practice sites.

Methods: Three hundred three symptomatic women, across 8 University of Pittsburgh Medical Center-affiliated clinics, were evaluated per standard office-based practice. Four of 5 vaginal swabs (1 cryopreserved) were collected for a US Food and Drug Administration-authorized nucleic acid amplification test (NAAT) for vaginitis/vaginosis diagnosis; Nugent scoring (BV); yeast culture (VVC); and a second NAAT (for TV). Two hundred ninety women had evaluable samples. Medical record extraction facilitated verification of treatments prescribed within 7 days of the index visit and return visit frequency within 90 days.

Results: Women had a mean age of 29.4 ± 6.5 years, 90% were not pregnant, 79% were of white race, and 38% reported vaginitis treatment within the past month. Point-of-care tests, including vaginal pH (15%), potassium hydroxide/whiff (21%), and wet mount microscopy (17%), were rarely performed. Of the 170 women having a laboratory-diagnosed cause of vaginitis, 81 (47%) received 1 or more inappropriate prescriptions. Of the 120 women without BV, TV, or VVC, 41 (34%) were prescribed antibiotics and/or antifungals. Among women without infectious vaginitis, return visits for vaginitis symptoms were more common among women treated empirically compared to those not receiving treatment (9/41 vs 5/79, P = .02).

Conclusions: Within a community practice setting, 42% of women having vaginitis symptoms received inappropriate treatment. Women without infections who received empiric treatment were more likely have recurrent visits within 90 days.

Clinical trials registration: NCT03151928.

Keywords: Trichomonas vaginalis; bacterial vaginosis; vulvovaginal candidiasis.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.

References

    1. Koumans EH, Sternberg M, Bruce C, et al. . The prevalence of bacterial vaginosis in the United States, 2001–2004; associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis 2007; 34:864–9.
    1. Sutton M, Sternberg M, Koumans EH, McQuillan G, Berman S, Markowitz L. The prevalence of Trichomonas vaginalis infection among reproductive-age women in the United States, 2001–2004. Clin Infect Dis 2007; 45:1319–26.
    1. Brotman RM, Klebanoff MA, Nansel TR, et al. . Bacterial vaginosis assessed by Gram stain and diminished colonization resistance to incident gonococcal, chlamydial, and trichomonal genital infection. J Infect Dis 2010; 202:1907–15.
    1. Cohen CR, Lingappa JR, Baeten JM, et al. . Bacterial vaginosis associated with increased risk of female-to-male HIV-1 transmission: a prospective cohort analysis among African couples. PLoS Med 2012; 9:e1001251.
    1. Nelson DB, Hanlon A, Hassan S, et al. . Preterm labor and bacterial vaginosis-associated bacteria among urban women. J Perinat Med 2009; 37:130–4.
    1. McClelland RS, Sangare L, Hassan WM, et al. . Infection with Trichomonas vaginalis increases the risk of HIV-1 acquisition. J Infect Dis 2007; 195:698–702.
    1. Cotch MF, Pastorek JG 2nd, Nugent RP, et al. . Trichomonas vaginalis associated with low birth weight and preterm delivery. The Vaginal Infections and Prematurity Study Group. Sex Transm Dis 1997; 24:353–60.
    1. Kissinger P, Amedee A, Clark RA, et al. . Trichomonas vaginalis treatment reduces vaginal HIV-1 shedding. Sex Transm Dis 2009; 36:11–6.
    1. Van Der Pol B, Kwok C, Pierre-Louis B, et al. . Trichomonas vaginalis infection and human immunodeficiency virus acquisition in African women. J Infect Dis 2008; 197:548–54.
    1. Beigi RH, Meyn LA, Moore DM, Krohn MA, Hillier SL. Vaginal yeast colonization in nonpregnant women: a longitudinal study. Obstet Gynecol 2004; 104:926–30.
    1. Yano J, Sobel JD, Nyirjesy P, et al. . Current patient perspectives of vulvovaginal candidiasis: incidence, symptoms, management and post-treatment outcomes. BMC Women’s Health 2019; 19:48.
    1. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Morb Mortal Wkly Rep 2015; 64.
    1. Bornstein J, Lakovsky Y, Lavi I, Bar-Am A, Abramovici H. The classic approach to diagnosis of vulvovaginitis: a critical analysis. Infect Dis Obstet Gynecol 2001; 9:105–11.
    1. Nathan B, Appiah J, Saunders P, et al. . Microscopy outperformed in a comparison of five methods for detecting Trichomonas vaginalis in symptomatic women. Int J STD AIDS 2015; 26:251–6.
    1. Hilbert DW, Smith WL, Chadwick SG, et al. . Development and validation of a highly accurate quantitative real-time PCR assay for diagnosis of bacterial vaginosis. J Clin Microbiol 2016; 54:1017–24.
    1. Schwebke JR, Gaydos CA, Nyirjesy P, Paradis S, Kodsi S, Cooper CK. Diagnostic performance of a molecular test versus clinician assessment of vaginitis. J Clin Microbiol 2018; 56:e00252–18.
    1. Wendel KA, Erbelding EJ, Gaydos CA, Rompalo AM. Trichomonas vaginalis polymerase chain reaction compared with standard diagnostic and therapeutic protocols for detection and treatment of vaginal trichomoniasis. Clin Infect Dis 2002; 35:576–80.
    1. Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of Gram stain interpretation. J Clin Microbiol 1991; 29:297–301.
    1. Wiesenfeld HC, Macio I. The infrequent use of office-based diagnostic tests for vaginitis. Am J Obstet Gynecol 1999; 181:39–41.
    1. Aguirre-Quiñonero A, Castillo-Sedano IS, Calvo-Muro F, Canut-Blasco A. Accuracy of the BD MAX™ vaginal panel in the diagnosis of infectious vaginitis. Eur J Clin Microbiol Infect Dis 2019; 38:877–82.
    1. Gaydos CA, Beqaj S, Schwebke JR, et al. . Clinical validation of a test for the diagnosis of vaginitis. Obstet Gynecol 2017; 130:181–9.
    1. DeMarco AL, Rabe LK, Austin MN, et al. . Survival of vaginal microorganisms in three commercially available transport systems. Anaerobe 2017; 45:44–9.
    1. Allen-Davis JT, Beck A, Parker R, Ellis JL, Polley D. Assessment of vulvovaginal complaints: accuracy of telephone triage and in-office diagnosis. Obstet Gynecol 2002; 99:18–22.
    1. Schwebke JR, Taylor SN, Ackerman N, et al. . Clinical validation of the Aptima bacterial vaginosis and Aptima Candida/Trichomonas vaginitis assays: results from a prospective multi-center clinical study. J Clin Microbiol 2019. doi:10.1128/JCM.01643-19.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren