Predictive value of the clinical diagnosis of lower genital tract infection in women.


Journal Article

OBJECTIVE: We hypothesized that diagnostic approaches to lower genital tract infections are inaccurate and proposed this study to evaluate typical approaches. STUDY DESIGN: Clinical diagnoses were made with symptoms, direct observation, wet mount, vaginal pH, and amines in 598 women with genital complaints. Laboratory testing for N gonorrhoeae, yeast, T vaginalis, C trachomatis, and bacterial vaginosis by Gram stain. RESULTS: The most frequent symptoms were vaginal discharge (64%), change in discharge (53%), malodor (48%), and pruritus (32%). The infection rates were 46% bacterial vaginosis, 29% yeast, 12% trichomoniasis, 11% chlamydia or gonorrhea; 21% of the patients had no infection. The symptoms did not predict laboratory diagnosis. Clinical signs and symptoms with office-based tests and microscopy improved the accuracy of diagnoses. Amsel's clinical diagnosis of bacterial vaginosis was the most sensitive at 92%. The sensitivity of wet mount diagnosis of trichomoniasis was 62%, of yeast by microscopy was 22%, and of mucopus for the prediction of gonorrhea and/or chlamydia was 30%. CONCLUSION: Symptoms alone should not be used to direct treatment in instances in which resources permit more complete evaluation with office-based testing that includes microscopy. Treatment failures or diagnostic uncertainty should prompt specific laboratory testing.

Full Text

Cited Authors

  • Landers, DV; Wiesenfeld, HC; Heine, RP; Krohn, MA; Hillier, SL

Published Date

  • April 2004

Published In

Volume / Issue

  • 190 / 4

Start / End Page

  • 1004 - 1010

PubMed ID

  • 15118630

Pubmed Central ID

  • 15118630

Electronic International Standard Serial Number (EISSN)

  • 1097-6868

International Standard Serial Number (ISSN)

  • 0002-9378

Digital Object Identifier (DOI)

  • 10.1016/j.ajog.2004.02.015


  • eng