IngentaConnect A comparative study of clinical management strategies for vaginal...

Authors: Catriona Melville¹; Rak Nandwani²; Alison Bigrigg³; Alex D. McMahon⁴

Source: Journal of Family Planning and Reproductive Health Care, Volume 31, Number 1, January 2005 , pp. 26-30(5)

Publisher: Faculty of Sexual and Reproductive Healthcare

Abstract:

Objective To compare strategies for management of women with vaginal discharge in genitourinary medicine (GUM) and family planning (FP) settings.

Methods The setting was a centre housing both FP and GUM departments within a primary care trust in Scotland. The study participants were 200 women presenting with vaginal discharge. A randomised, controlled, crossover design was employed. Strategies typical of FP and GUM were performed on every participant in a randomised sequence. Day 1 diagnoses were made by the FP strategy (history and examination) and the GUM strategy (nearpatient microscopy added). Day 7 results were obtained from final analysis of all specimens. Days 1 and 7 results were compared with the reference standard provided by all the test results. The main outcome measures were incorrect diagnoses on Days 1 and 7.

Results On Day 1 the FP strategy resulted in significantly more incorrect diagnoses than the GUM strategy when compared with the reference standard (73 vs 32; p <0.001). On Day 7 the GUM strategy resulted in significantly more incorrect diagnoses than the FP strategy when compared with the reference standard (32 vs 17; p = 0.019).

Conclusions Vaginal discharge can be managed effectively in community settings such as FP and primary care. The addition of near-patient microscopy produces a more accurate immediate diagnosis. The addition of a high vaginal swab for culture produces a more accurate final diagnosis. The costs of on-site microscopy must be considered.

Document Type: Research article

DOI: 10.1783/0000000052973112

Affiliations: 1: Specialist Registrar in Obstetrics and Gynaecology, West of Scotland Region, The Sandyford Initiative, Glasgow, UK 2: Associate Director and Consultant in HIV/Genitourinary Medicine, The Sandyford Initiative, Glasgow, UK 3: Director and Consultant in Community Gynaecology, The Sandyford Initiative, Glasgow, UK 4: Senior Statistician, Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK

A comparative study of clinical management strategies for vaginal discharge in family planning and genitourinary medicine settings