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Syndromic Diagnosis in Evaluation of Women with Symptoms of Vaginitis

  • Theophilus Ogochukwu NwankwoEmail author
  • Uzochukwu Uzoma Aniebue
  • Uchenna Anthony Umeh
Female Genital Tract Infections (J Sobel, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Female Genital Tract Infections

Abstract

Purpose of review

This review aims to determine the effectiveness of the use of syndrome diagnosis in the evaluation of vaginitis and to make suggestions based on the review findings.

Recent findings

Vaginal discharge as the main symptom of vaginitis is unspecific. A randomized study of symptom-based diagnosis and treatment of vaginitis in the USA favored symptoms used for treatment; however, this was only a pilot study. Hence, a population-based study is necessary to validate these findings. Most of the study that assessed treatment of vaginitis in pregnancy reported low diagnostic sensitivity and specificity for bacterial vaginosis and vaginal candidiasis and a wide range for trichomonas vaginalis reflecting ineffectiveness of syndrome-based treatment in pregnancy.

Summary

A systematic review of the web for relevant literature was made, and appropriate articles were extracted and reviewed. Sensitivity, specificity, and positive values were used, where applicable to determine effectiveness. Forty-three full articles and abstracts were reviewed. Studies that validated or applied WHO algorithm for treatment of vaginitis reported high sensitivity (91.5–100%) but moderate to low specificity (0–27.5%) among women with vaginal symptoms. Studies that focused on symptoms for diagnosis of the three main etiologic agents of vaginitis reported low sensitivity and specificity, while such studies in pregnancy reported sensitivity and specificity ranging from 35.4 to 54% for TV, 11 to 100% for BV, and 0 to 56.2% for trichomonas vaginalis, bacterial vaginosis, and vaginal candidiasis, respectively. Studies that added point of care test reported higher sensitivity and specificity and positive predictive value. The use of WHO syndrome-based algorithm or its modification for treatment of vaginitis though moderately effective has the potential for overtreatment and physician error. Point of care testing and laboratory investigation are essential for productive intervention especially in pregnancy.

Keywords

Syndromic evaluation Vaginitis Bacteria vaginosis Trichomonas vaginalis Vaginal candidiasis 

Notes

Compliance with Ethical Standards

Conflict of Interest

Drs. Nwankwo, Aniebue, and Anthony declare no conflict of interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Theophilus Ogochukwu Nwankwo
    • 1
    Email author
  • Uzochukwu Uzoma Aniebue
    • 1
  • Uchenna Anthony Umeh
    • 1
  1. 1.Department of Obstetrics and GynaecologyUniversity of Nigeria NsukkaNsukkaNigeria

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