Concordance Between Clinical and Laboratory Diagnosis of Abnormal Vaginal Discharge in Chilean Women

Abstract

Objective To determine the concordance between the clinical diagnosis of women with abnormal vaginal discharge (AVD) and laboratory results using molecular detection and observation of the vaginal microbiota.

Methods Cross-sectional study conducted in 2018 in Temuco, Chile. A total of 25 midwives from 12 health centers participated. A total of 125 women > 18 years old, volunteers, were recruited. The sample of the posterior vaginal fornix was obtained by speculoscopy. Characteristics of the discharge and of the external and internal genitalia were observed. Gram staining was used to observe vaginal microbiota, blastoconidia and pseudohyphae, and polymerase chain reaction was used for the detection of Trichomonas vaginalis and Candida albicans. The Cohen kappa coefficient was used in the concordance analysis.

Results Out of a total of 125 women with AVD, 85.6% consulted spontaneously and 14.4% were diagnosed clinically during a routine check-up. Absolute concordance was significant (p = 0.0012), with an agreement of 13.6%. The relative concordance was significant, but fair for bacterial vaginosis (Kappa = 0.21; p = 0.003) and candidiasis (Kappa = 0.22; p = 0.001), and slight for trichomoniasis (Kappa = 0.14; p = 0.009). The percentage of coincidence of the diagnoses (single or mixed) by laboratory and midwives was: bacterial vaginosis 63.2% (12/19), candidiasis 36.5% (27/74), and trichomoniasis 12.5% (4/32). There was 20% coinfection. A total of 36% of the clinical diagnoses of AVD had negative laboratory tests.

Conclusion The vulvovaginitis conditions candidiasis and trichomoniasis appear to be overdiagnosed, and bacterial vaginosis appears to be underdiagnosed by the clinical diagnosis when compared with the laboratory diagnosis. The low concordance obtained shows the importance of complementing the clinical diagnosis with a laboratory study of AVD, particularly in women with failed treatments and/or coinfections with unspecific and varying signs and symptoms.

Resumo

Objetivo  Determinar a concordância entre o diagnóstico clínico de mulheres com corrimento vaginal anormal (AVD) e os resultados laboratoriais por meio da detecção molecular e observação da microbiota vaginal.

Métodos Estudo transversal realizado em 2018 em Temuco, Chile. Participaram 25 parteiras de 12 centros de saúde. Um total de 125 mulheres > 18 anos, voluntárias, foram recrutadas. A amostra do fórnice vaginal posterior foi obtida por especuloscopia. Foram observadas características da secreção e da genitália externa e interna. A coloração de Gram foi usada para observar a microbiota vaginal, blastoconídios e pseudo-hifas, e a reação em cadeia da polimerase foi usada para a detecção de Trichomonas vaginalis e Candida albicans. O coeficiente kappa de Cohen foi usado na análise de concordância.

Resultados De um total de 125 mulheres com AVD, 85,6% consultaram espontaneamente e 14,4% foram diagnosticados clinicamente durante um check-up de rotina. A concordância absoluta foi significativa (p = 0,0012), com concordância de 13,6%. A concordância relativa foi significativa, mas razoável para vaginose bacteriana (Kappa = 0,21; p = 0,003) e candidíase (Kappa = 0,22; p = 0,001), e leve para tricomoníase (Kappa = 0,14; p = 0,009). O percentual de coincidência dos diagnósticos (solteiros ou mistos) por laboratório e parteiras foi: vaginose bacteriana 63,2% (12/19), candidíase 36,5% (27/74) e tricomoníase 12,5% (4/32). Houve 20% de coinfecção. Um total de 36% dos diagnósticos clínicos de AVD tiveram exames laboratoriais negativos.

Conclusão As condições de vulvovaginite candidíase e tricomoníase parecem ser sobrediagnosticadas, e a vaginose bacteriana parece ser subdiagnosticada pelo diagnóstico clínico quando comparado com o diagnóstico laboratorial. A baixa concordância obtida mostra a importância de complementar o diagnóstico clínico com estudo laboratorial de AVD, principalmente em mulheres com falha de tratamento e / ou coinfecções com sinais e sintomas inespecíficos e variáveis.

Keywords

vaginal discharge - laboratory diagnosis - bacterial vaginosis - candidiasis - trichomonas vaginalis

Palavras-chave

corrimento vaginal - diagnóstico laboratorial - vaginose bacteriana - candidíase - trichomonas vaginalis

Contributors

All the authors contributed with the project and data interpretation, the writing of the article, the critical review of the intellectual content, and with the final approval of the version to be published.

Publikationsverlauf

Eingereicht: 11. Mai 2020

Angenommen: 02. August 2021

Artikel online veröffentlicht:
21. September 2021

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