Self-taken vaginal swabs versus clinician-taken for detection of candida and bacterial vaginosis

a case-control study in primary care

Pam Barnes, Rute Vieira, Jayne Harwood, Mayur Chauhan

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND: Vaginal discharge and vulvitis are common presenting symptoms in general practice. Few studies have specifically looked at the validity of self-taken low vulvovaginal swabs (LVS) for the diagnosis of vulvovaginal candidiasis (VVC) and bacterial vaginosis (BV).

AIM: To assess if patient self-taken LVS are a valid alternative to clinician-taken high vaginal swabs (HVS) for the detection of VVC and BV.

DESIGN AND SETTING: Case-control study with the patient acting as their own control in an urban sexual health centre in Newcastle upon Tyne, UK.

METHOD: Females aged 16-65 years attending with symptomatic vaginal discharge, vulval irritation, genital pain, and an offensive genital smell were recruited into the study. Participants took a self-taken LVS before vaginal examination, during which a clinician took an HVS (reference standard). Main outcome measures were the diagnosis of BV or VVC infection.

RESULTS: A total of 104 females were enrolled. Of those, 45 were diagnosed with VVC and 26 with BV. The sensitivities of self-taken LVS for VVC and BV were 95.5% and 88.5% respectively. Cohen's κ coefficient showed 'strong agreement' for the detection of both VVC and BV. Vulval itching was the most common symptom associated with VVC (69%), whereas 50% of females diagnosed with BV presented with an offensive discharge. Both symptoms had poor positive predictive values (0.63 and 0.50, respectively).

CONCLUSION: Self-taken LVS appears to be a valid alternative to clinician-taken HVS for detecting VVC and BV infections. Symptoms were found to be a poor indicator of underlying infection.

Original languageEnglish
Pages (from-to)e824-e829
Number of pages6
JournalThe British Journal of General Practice
Volume67
Issue number665
DOIs
Publication statusPublished - Dec 2017

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Vulvovaginal Candidiasis
Bacterial Vaginosis
Candida
Case-Control Studies
Primary Health Care
Vaginal Discharge
Vulvitis
Urban Health
Gynecological Examination
Smell
Reproductive Health
Pruritus
Infection
Bacterial Infections
General Practice
Outcome Assessment (Health Care)
Pain

Keywords

  • Journal Article

Cite this

Self-taken vaginal swabs versus clinician-taken for detection of candida and bacterial vaginosis : a case-control study in primary care. / Barnes, Pam; Vieira, Rute; Harwood, Jayne; Chauhan, Mayur.

In: The British Journal of General Practice, Vol. 67, No. 665, 12.2017, p. e824-e829.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Vaginal discharge and vulvitis are common presenting symptoms in general practice. Few studies have specifically looked at the validity of self-taken low vulvovaginal swabs (LVS) for the diagnosis of vulvovaginal candidiasis (VVC) and bacterial vaginosis (BV).AIM: To assess if patient self-taken LVS are a valid alternative to clinician-taken high vaginal swabs (HVS) for the detection of VVC and BV.DESIGN AND SETTING: Case-control study with the patient acting as their own control in an urban sexual health centre in Newcastle upon Tyne, UK.METHOD: Females aged 16-65 years attending with symptomatic vaginal discharge, vulval irritation, genital pain, and an offensive genital smell were recruited into the study. Participants took a self-taken LVS before vaginal examination, during which a clinician took an HVS (reference standard). Main outcome measures were the diagnosis of BV or VVC infection.RESULTS: A total of 104 females were enrolled. Of those, 45 were diagnosed with VVC and 26 with BV. The sensitivities of self-taken LVS for VVC and BV were 95.5{\%} and 88.5{\%} respectively. Cohen's κ coefficient showed 'strong agreement' for the detection of both VVC and BV. Vulval itching was the most common symptom associated with VVC (69{\%}), whereas 50{\%} of females diagnosed with BV presented with an offensive discharge. Both symptoms had poor positive predictive values (0.63 and 0.50, respectively).CONCLUSION: Self-taken LVS appears to be a valid alternative to clinician-taken HVS for detecting VVC and BV infections. Symptoms were found to be a poor indicator of underlying infection.",
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N2 - BACKGROUND: Vaginal discharge and vulvitis are common presenting symptoms in general practice. Few studies have specifically looked at the validity of self-taken low vulvovaginal swabs (LVS) for the diagnosis of vulvovaginal candidiasis (VVC) and bacterial vaginosis (BV).AIM: To assess if patient self-taken LVS are a valid alternative to clinician-taken high vaginal swabs (HVS) for the detection of VVC and BV.DESIGN AND SETTING: Case-control study with the patient acting as their own control in an urban sexual health centre in Newcastle upon Tyne, UK.METHOD: Females aged 16-65 years attending with symptomatic vaginal discharge, vulval irritation, genital pain, and an offensive genital smell were recruited into the study. Participants took a self-taken LVS before vaginal examination, during which a clinician took an HVS (reference standard). Main outcome measures were the diagnosis of BV or VVC infection.RESULTS: A total of 104 females were enrolled. Of those, 45 were diagnosed with VVC and 26 with BV. The sensitivities of self-taken LVS for VVC and BV were 95.5% and 88.5% respectively. Cohen's κ coefficient showed 'strong agreement' for the detection of both VVC and BV. Vulval itching was the most common symptom associated with VVC (69%), whereas 50% of females diagnosed with BV presented with an offensive discharge. Both symptoms had poor positive predictive values (0.63 and 0.50, respectively).CONCLUSION: Self-taken LVS appears to be a valid alternative to clinician-taken HVS for detecting VVC and BV infections. Symptoms were found to be a poor indicator of underlying infection.

AB - BACKGROUND: Vaginal discharge and vulvitis are common presenting symptoms in general practice. Few studies have specifically looked at the validity of self-taken low vulvovaginal swabs (LVS) for the diagnosis of vulvovaginal candidiasis (VVC) and bacterial vaginosis (BV).AIM: To assess if patient self-taken LVS are a valid alternative to clinician-taken high vaginal swabs (HVS) for the detection of VVC and BV.DESIGN AND SETTING: Case-control study with the patient acting as their own control in an urban sexual health centre in Newcastle upon Tyne, UK.METHOD: Females aged 16-65 years attending with symptomatic vaginal discharge, vulval irritation, genital pain, and an offensive genital smell were recruited into the study. Participants took a self-taken LVS before vaginal examination, during which a clinician took an HVS (reference standard). Main outcome measures were the diagnosis of BV or VVC infection.RESULTS: A total of 104 females were enrolled. Of those, 45 were diagnosed with VVC and 26 with BV. The sensitivities of self-taken LVS for VVC and BV were 95.5% and 88.5% respectively. Cohen's κ coefficient showed 'strong agreement' for the detection of both VVC and BV. Vulval itching was the most common symptom associated with VVC (69%), whereas 50% of females diagnosed with BV presented with an offensive discharge. Both symptoms had poor positive predictive values (0.63 and 0.50, respectively).CONCLUSION: Self-taken LVS appears to be a valid alternative to clinician-taken HVS for detecting VVC and BV infections. Symptoms were found to be a poor indicator of underlying infection.

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