OFFICE LABORATORY DIAGNOSIS OF VAGINITIS - CLINICIAN-PERFORMED TESTS COMPARED WITH A RAPID NUCLEIC-ACID HYBRIDIZATION TEST

Background. The traditional diagnosis of vaginitis incorporates patien t symptoms, clinical findings observed during vaginal examination, and laboratory analysis of vaginal fluid. The purpose of this study was t o evaluate routine clinician-performed office laboratory diagnostic te chniques for women with abnormal vaginal symptoms, and to compare thes e results with those obtained by a DNA hybridization test for Trichomo nas vaginalis, Gardnerella varginalis, and Candida species. Methods. T he study included 501 symptomatic women who were between the ages of 1 4 and 67 years. Three vaginal specimens were obtained for saline wet m ount, potassium hydroxide (KOH) prep, amine ''sniff,'' pH, and nucleic acid hybridization (T vaginalis, G vaginalis, and Candida sp) tests. Clinicians and medical technicians independently evaluated the wet mou nt, KOH prep, amine, and pH tests. A medical technician processed the DNA tests according to manufacturer's protocol. Results. Of 499 subjec ts for whom complete data were available, vulvovaginal candidiasis was diagnosed in 20.0%, vaginal trichomoniasis in 7.4%, and bacterial vag inosis in 52.1%. Fourteen percent of subjects had multiple vaginal inf ections. The sensitivity and specificity of clinician microscopically diagnosed vulvovaginal candidiasis, vaginal trichomoniasis, and bacter ial vaginosis were 39.6% and 90.4%, 75.0% and 96.6%, and 76.5% and 70. 8%, respectively. The sensitivity and specificity of the DNA probe dia gnosis of the same types of vaginitis were 75.0% and 95.7%, 86.5% and 98.5%, and 95.4% and 60.7%, respectively. When only women with multipl e vaginal infections were considered, the percentages of correct clini cian diagnoses for vulvovaginal candidiasis, vaginal trichomoniasis, a nd bacterial vaginosis were 49.3%, 83.6%, and 59.7%, respectively. For the DNA probe test, the percentages of correct diagnoses were 72.9%, 92.9%, and 90.0%, respectively. Conclusions. Primary care clinicians d emonstrated a high specificity but low sensitivity when identifying va ginal trichomoniasis and vulvovaginal candidiasis by microscopic techn iques. Correct microscopic diagnosis of bacterial vaginosis was even m ore difficult for clinicians, as was the diagnosis of multiple vaginal infections. Clinicians were not as accurate as the DNA probe test in diagnosing vaginal infections. Clinicians need more education in the l aboratory diagnosis of vaginitis. Clinicians should carefully scrutini ze each microscopic slide, systematically examine the slide for each t ype of vaginitis, and consider specimen pH and the presence of leukocy tes, Lactobacillus organisms, or amine odor as additional clues to inf ection.