Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, MSC 105580, 1 UNM, Albuquerque, NM 87131, USA.
Sex Transm Infect. 2013 May;89(3):185-90. doi: 10.1136/sextrans-2012-050550. Epub 2012 Sep 27.
We evaluated agreement in diagnoses for bacterial vaginosis (BV), Trichomonas vaginalis (TV) and vulvovaginal candidiasis (VVC) between clinicians examining the patient and performing diagnostic tests versus a clinician with access only to the patient's history and diagnostic findings from self-obtained vaginal swabs (SOVS).
Women presenting with vaginal discharge to a sexually transmitted infections clinic provided SOVS for evaluation and completed the study and qualitative questionnaires. A clinician then obtained a history and performed speculum and bimanual examinations. Participants' history and diagnostic test results from SOVS were provided to a masked non-examining clinician who rendered independent diagnoses. Overall agreement in diagnoses and κ statistics was calculated.
The prevalence of infections among the 197 participants was 63.4% (BV), 19% (TV) and 14% (VVC). The per cent agreement between the examining and non-examining clinician for the diagnoses of BV was 68.5%, 90.9% for TV and 91.9% for VVC. Of the 105 women diagnosed with BV by the examining clinician, 34 (32%) were missed by the non-examining clinician. The non-examining clinician missed 13 (48%) of 27 women and 12 (34%) of 35 women treated for VVC and TV, respectively. Four women who all presented with abdominal pain were diagnosed with pelvic inflammatory disease.
Tests from SOVS and history alone cannot be used to adequately diagnose BV, TV and VVC in women presenting with symptomatic vaginal discharge. Cost benefits from eliminating the speculum examination and using only tests from SOVS may be negated by long-term costs of mistreatment.
我们评估了临床医生检查患者和进行诊断性检查与仅获取患者病史和自我采集阴道拭子（SOVS）诊断结果的临床医生之间在细菌性阴道病（BV）、阴道毛滴虫（TV）和外阴阴道念珠菌病（VVC）诊断方面的一致性。
患有阴道分泌物的女性到性传播感染诊所提供 SOVS 进行评估，并完成研究和定性问卷。然后，临床医生获取病史并进行阴道镜和双合诊检查。参与者的病史和 SOVS 诊断测试结果提供给一位盲目的非检查临床医生，由其做出独立诊断。计算了总体诊断一致性和κ统计量。
197 名参与者中感染的患病率为 63.4%（BV）、19%（TV）和 14%（VVC）。检查和非检查临床医生对 BV 诊断的一致性百分比为 68.5%，对 TV 的一致性百分比为 90.9%，对 VVC 的一致性百分比为 91.9%。在检查临床医生诊断为 BV 的 105 名女性中，有 34 名（32%）被非检查临床医生漏诊。非检查临床医生漏诊了 27 名女性中的 13 名（48%）和 35 名女性中的 12 名（34%），她们分别患有 VVC 和 TV。4 名均表现为腹痛的女性被诊断为盆腔炎。
对于有症状阴道分泌物的女性，单独使用 SOVS 和病史不能充分诊断 BV、TV 和 VVC。从消除阴道镜检查和仅使用 SOVS 测试的成本效益可能因治疗不当的长期成本而被否定。
