Some aspects of the diagnosis of specific vaginal infections in the Rotterdam STD clinic population

Abstract

We studied specific vaginal infections in 351 consecutive women who visited the Rotterdam STD clinic. Prostitutes less often had vaginal or vulvar complaints than non-prostitutes (Fisher test, p < 0.01), but more often had abnormal discharge (Fisher test, p < 0.001). Normal secretions were found in 52% of the women. Clue cell-positive discharge (CCPD) was by far the most prevalent vaginal disease entity (32%). The wet mount showed pseudo-hyphae in 14 women (4%) and Trichomonas vaginalis was detected in 20 (6%). Microscopy (normal saline, no KOH 10%) had an overall sensitivity of 18% in the diagnosis of vaginal yeast infection. The sensitivity substantially rose with the ‘degree’ of infection. In the case of trichomoniasis the sensitivity was 55%. The rates of positive cultures of Candida species, T. vaginalis, N. gonorrhoeae and C. trachomatis were 21%, 13%, 9% and 10% respectively. Symptoms and signs were not of much help in the correct classification of the different diagnostic categories due to considerable overlap. However, curdy secretions are indicative of candidal infection. Tests for anaerobic overgrowth showed a 99% correct classification of normal secretions, which implies that smelling the vaginal secretions on the withdrawn speculum is a major diagnostic office procedure.