van den Munckhof et al reported an algorithm for evaluating a woman with an abnormal vaginal discharge. The authors are from multiple institutions in The Netherlands.
Population: females at low risk for STI and for trichomoniasis
Parameters:
(1) vaginal pH test
(2) amine odor test
(3) lower abdominal discomfort
Vaginal pH
Amine Odor
Lower Abdominal Discomfort
Evaluation
<= 4.5
NA
NA
vulvovaginal candidiasis
> 4.5
positive
NA
bacterial vaginosis
> 4.5
negative
positive
aerobic vaginitis
> 4.5
negative
negative
bacterial vaginosis and vulvovaginal candidiasis
where:
• Aerobic vaginitis may be due to Streptococcus agalactiae, Staphylococcus aureus, E. coli, or other species.
Evaluation for
Testing
vulvovaginal candidiasis
qPCR or yeast culture
bacterial vaginosis
qPCR
aerobic vaginitis
aerobic culture
If the population has risk for STI or trichomoniasis, then additional testing is required.
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