Women's Health

Treatment without examination and lab tests appears effective for some women with vaginal symptoms

Physicians who treat women suffering from bacterial vaginosis, trichomoniasis, or vaginal candidiasis make their diagnosis through microscopy, pH testing, and the "whiff" test. To gather vaginal discharge samples for these tests, the physician must have the woman undergo a speculum examination. Yet offering some women treatment for these uncomfortable conditions based on their symptoms and skipping speculum examination and lab tests may be appropriate, finds a new study.

The 23 women who received treatment for their vaginal symptoms without examination had outcomes and satisfaction ratings for their care similar to the 21 women who underwent traditional examination and laboratory tests. In fact, symptoms for 93 percent of all 44 women improved in the 2-week followup period, and 64 percent of women no longer had symptoms. Further, both physicians and patients accepted this approach.

While the approach was effective, clinicians are still tasked with determining which patients may have more serious conditions and require additional examination. In fact, because 7 percent of the women had a sexually transmitted disease (STD) such as chlamydia or gonorrhea, Matthew Anderson, M.D., M.Sc., of the Montefiore Medical Center, and colleagues conclude that testing for STDs is important when women have vaginal symptoms. This study was funded in part by the Agency for Healthcare Research and Quality (HS16050).

See "Are a speculum examination and wet mount always necessary for patients with vaginal symptoms? A pilot randomized controlled trial," by Dr. Anderson, Andreas Cohrssen, M.D., Kathleen Klink, M.D., and Danit Brahver, B.S., in the November/December 2009 Journal of the American Board of Family Medicine 22(6), pp. 617-624.

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