Concordance Between Clinical and Laboratory Diagnosis of Abnormal Vaginal Discharge in Chilean Women

Abstract

Objective To determine the concordance between the clinical diagnosis of women with abnormal vaginal discharge (AVD) and laboratory results using molecular detection and observation of the vaginal microbiota. Methods Cross-sectional study conducted in 2018 in Temuco, Chile. A total of 25 midwives from 12 health centers participated. A total of 125 women > 18 years old, volunteers, were recruited. The sample of the posterior vaginal fornix was obtained by speculoscopy. Characteristics of the discharge and of the external and internal genitalia were observed. Gram staining was used to observe vaginal microbiota, blastoconidia and pseudohyphae, and polymerase chain reaction was used for the detection of Trichomonas vaginalis and Candida albicans. The Cohen kappa coefficient was used in the concordance analysis. Results Out of a total of 125 women with AVD, 85.6% consulted spontaneously and 14.4% were diagnosed clinically during a routine check-up. Absolute concordance was significant (p = 0.0012), with an agreement of 13.6%. The relative concordance was significant, but fair for bacterial vaginosis (Kappa = 0.21; p = 0.003) and candidiasis (Kappa = 0.22; p = 0.001), and slight for trichomoniasis (Kappa = 0.14; p = 0.009). The percentage of coincidence of the diagnoses (single or mixed) by laboratory and midwives was: bacterial vaginosis 63.2% (12/19), candidiasis 36.5% (27/74), and trichomoniasis 12.5% (4/32). There was 20% coinfection. A total of 36% of the clinical diagnoses of AVD had negative laboratory tests. Conclusion The vulvovaginitis conditions candidiasis and trichomoniasis appear to be overdiagnosed, and bacterial vaginosis appears to be underdiagnosed by the clinical diagnosis when compared with the laboratory diagnosis. The low concordance obtained shows the importance of complementing the clinical diagnosis with a laboratory study of AVD, particularly in women with failed treatments and/or coinfections with unspecific and varying signs and symptoms.

Importance of Candida infection and fluconazole resistance in women with vaginal discharge syndrome in Namibia

“…In contrast, another study illustrated that biofilms related to VVC may act as a reservoir for Chlamydia trachomatis [3]. STIs have been suggested in other studies as risk factor for VVC; however, this relationship should be further confirmed [45,46]. In our study, like most other studies looking at the species distribution of Candida, the most prevalent Candida species isolated was C. albicans, followed by C. glabrata [47,48].…”

“…In contrast, another study illustrated that biofilms related to VVC may act as a reservoir for Chlamydia trachomatis [ 3 ]. STIs have been suggested in other studies as risk factor for VVC; however, this relationship should be further confirmed [ 45 , 46 ].…”

Rationale of Cross-Sectional Descriptive Study on Clinical Effectiveness of Oral Combination Therapy Based on Secnidazole, Azithromycin and Fluconazole in Syndromic Treatment of Abnormal Vaginal Discharge in Kinshasa/DR Congo

“…On the other hand, expensive laboratory tests and the extended waiting period remain an obstacle to initiating targeted treatment, hence the importance of a therapeutic combination that is effective on all these germs. We believe that combined kit including Azythromycin, Fluconazole and Secnidazole could fulfill this role [15] [16].…”

Vaginose citolítica: revisão de escopo

“…Parte dessa disfunção advém de um crescimento excessivo de lactobacilos. Apesar de manterem o pH vaginal adequado (4,0 -4,5%), protegendo a microbiota vaginal contra infecções causadas por agentes como a E. coli, Candida spp., Gardnerella vaginalis e Mobilincus spp., os lactobacilos isolados ou combinados com outras bactérias, podem gerar um dano ao epitélio vaginal intermediário e resultar em um desgaste celular expressivo, levando à uma doença chamada vaginose citolítica (VC) (Hacisalihoğlu & Acet, 2021;Melo et al, 2021;Carter et al, 2022).…”