Vaginitis testing outcomes by documented symptom status in a student-run free clinic: a retrospective study.
Documented symptom status did not consistently match test results for vaginitis in this clinic population, indicating potential issues with symptom-based diagnosis.
Where it sits
this study against the rest of the ll-37 corpusSummary and findings
This study assessed vaginitis testing outcomes in a student-run free clinic, focusing on patients with and without documented symptoms. A total of 104 testing encounters were reviewed for bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), or trichomoniasis vaginalis (TV). No significant differences were found in test results based on symptom status.
Abstract
<h4>Background</h4>Vaginitis is a common gynaecologic condition in patients assigned female at birth in the United States, most often caused by bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), or trichomoniasis vaginalis (TV). Symptoms such as discharge, irritation, and burning often overlap. Symptom-based diagnosis is frequently inaccurate, with correct identification in only about half of cases. Empiric treatment without confirmatory testing remains common and can drive inappropriate therapy and antimicrobial resistance. Uninsured populations face higher infection burdens and barriers to care, yet data on vaginitis testing outcomes in student-run free clinics (SRFCs) are limited.<h4>Methods</h4>We conducted an IRB-approved retrospective chart review of patients receiving vaginitis testing at a no-cost SRFC affiliated with a Midwestern academic medical centre between October 2019 and November 2023. 104 testing encounters met inclusion criteria for BV, VVC, or TV testing. Demographics, age, and symptom status were extracted from the electronic medical record. Encounters were categorised as having documented vaginitis symptoms or no documented symptoms at the time of testing. All tests used transcription-mediated amplification. Proportional-difference chi-square tests compared results by symptom status, and logistic regression assessed associations between age and positive test results.<h4>Results</h4>The sample was predominantly comprised of patients assigned female at birth with a mean age of 31.1 years; 38% identified as Black. No significant differences were observed in positive or negative BV, VVC, or TV test results between encounters with and without documented vaginitis symptoms. Comparisons of positive VVC and TV results were limited by the small number of positive cases. Age was not associated with testing positive for BV, VVC, or TV.<h4>Conclusions</h4>Documented symptom status did not consistently correspond with organism-specific test results in this uninsured clinic population. Findings among patients without documented symptoms should be interpreted cautiously because testing was frequently bundled and symptom status was determined retrospectively.
Background
This paper addresses the accuracy of symptom-based diagnosis of vaginitis, a common condition among patients assigned female at birth in the U.S. Previous studies indicate that symptom-based diagnoses can be inaccurate, with correct identification in only about half of cases. The study is significant as it explores vaginitis testing outcomes in uninsured populations, where data is limited.
Methods
The study employed a retrospective chart review design, analyzing 104 testing encounters for BV, VVC, or TV at a student-run free clinic from October 2019 to November 2023. The population consisted predominantly of patients assigned female at birth, with demographics and symptom status extracted from electronic medical records. Proportional-difference chi-square tests and logistic regression were used to analyze the data.
Results
The analysis revealed no significant differences in positive or negative test results for BV, VVC, or TV based on documented symptom status. Comparisons of positive results for VVC and TV were limited due to a small number of positive cases. Age was not found to be associated with positive test results for any of the conditions.
Interpretation
The findings suggest that documented symptom status does not reliably predict organism-specific test results in this population. This aligns with previous literature indicating that symptom-based diagnoses can be misleading. However, the small sample size and retrospective design limit the conclusions that can be drawn, particularly regarding the clinical implications of these results.
Key findings
- Mean age of patients was 31.1 years.
- 38% of patients identified as Black.
- No significant differences in positive or negative BV, VVC, or TV test results between encounters with and without documented symptoms.
Limitations
- Retrospective study design.
- Small sample size of 104 encounters.
- Symptom status determined retrospectively.
- Testing frequently bundled, complicating interpretation.