Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (270 page)

   An FDA-approved nonamplified molecular probe assay (Affirm VP III Microbial Identification System, Becton Dickinson) showed good specificity with sensitivity (approximately 65%) compared to NAAT.

   Antigen testing (e.g., Trichomonas Rapid Test) provides rapid results with good sensitivity (approximately 90%) and specificity (>95%).

   Culture: Commercially available culture shows good sensitivity (approximately 80%), but cultures must be incubated for 3–7 days before final results are available.

   Urinalysis:
T. vaginalis
may be an incidental finding in routine urinalysis.

Vulvovaginal Candidiasis

   
Candida albicans
is responsible for 80–90% of cases of vulvovaginal candidiasis, but
Candida glabrata
and other
Candida
species are capable of causing clinically significant candidiasis. Vulvar inflammation, edema, pain, and pruritus are common symptoms. Thick, adherent, curd-like vaginal secretions are well described, but thin secretions may be seen and are indistinguishable from other causes of vaginal infection. Vulvovaginal candidiasis is not significantly associated with sexual transmission.

   Factors associated with an increased risk of vulvovaginal candidiasis include the following:

   Contraceptive use (especially vaginal sponges and intrauterine devices)

   Current or recent antimicrobial therapy

   DM, especially when poorly controlled

   Increased estrogen levels caused by pregnancy or therapeutic estrogen administration

   Intrinsic or acquired immunodeficiency or immunosuppressive therapy

Suggested Readings

Anderson MR, Klink K, Cohrssen A. Evaluation of vaginal complaints.
JAMA.
2004;291:1368–1379.

Eckert LO. Acute vulvovaginitis.
N Engl J Med.
2006;355:1244–1252.

Goonan K. Chapter 34: Vaginitis. In: Khan F, Sachs HJ, Pechet L, et al., (eds).
Guide to Diagnostic Testing
. Philadelphia, PA: Lippincott Williams & Wilkins; 2002.

Hilmarsdáttir I, Hauksdáttir GS, Jáhannesdáttir JD, et al. Evaluation of a rapid gram stain interpretation method for diagnosis of bacterial vaginosis.
J Clin Microbiol.
2006;44:1139–1140.

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.