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Diagnosis and Treatment of Vaginal Discharge Syndromes in Community Practice Settings.
Clin Infect Dis. 2020 Apr 30 [Online ahead of print]CI

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.

Authors+Show Affiliations

Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA. University of Pittsburgh School of Medicine, Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA.Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA.Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA.University of Pittsburgh School of Medicine, Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA.University of Pittsburgh School of Medicine, Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA.Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA. University of Pittsburgh School of Medicine, Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32350529

Citation

Hillier, Sharon L., et al. "Diagnosis and Treatment of Vaginal Discharge Syndromes in Community Practice Settings." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 2020.
Hillier SL, Austin M, Macio I, et al. Diagnosis and Treatment of Vaginal Discharge Syndromes in Community Practice Settings. Clin Infect Dis. 2020.
Hillier, S. L., Austin, M., Macio, I., Meyn, L. A., Badway, D., & Beigi, R. (2020). Diagnosis and Treatment of Vaginal Discharge Syndromes in Community Practice Settings. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. https://doi.org/10.1093/cid/ciaa260
Hillier SL, et al. Diagnosis and Treatment of Vaginal Discharge Syndromes in Community Practice Settings. Clin Infect Dis. 2020 Apr 30; PubMed PMID: 32350529.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnosis and Treatment of Vaginal Discharge Syndromes in Community Practice Settings. AU - Hillier,Sharon L, AU - Austin,Michele, AU - Macio,Ingrid, AU - Meyn,Leslie A, AU - Badway,David, AU - Beigi,Richard, Y1 - 2020/04/30/ PY - 2019/11/26/received PY - 2020/03/12/accepted PY - 2020/5/1/entrez PY - 2020/5/1/pubmed PY - 2020/5/1/medline KW - Trichomonas vaginalis KW - bacterial vaginosis KW - vulvovaginal candidiasis JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. N2 - 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. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/32350529/Diagnosis_and_Treatment_of_Vaginal_Discharge_Syndromes_in_Community_Practice_Settings L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciaa260 DB - PRIME DP - Unbound Medicine ER -
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