New Study: One-Third of Women Receive Clinical Misdiagnosis of Vaginitis
In the paper, Performance of a Vaginal Panel Assay Compared With the Clinical Diagnosis of Vaginitis — which reports the findings from a BD clinical trial — the three causes of vaginitis (bacterial vaginosis [BV], vulvovaginal candidiasis [VVC] or Trichomonas vaginalis [TV]) were studied to compare clinician assessment with results from a molecular test. The study found that compared to the molecular test, clinician diagnosis missed 45.3 percent of positive cases (180 of 397) and incorrectly identified 12.3 percent of negative cases as positives (123 of 879).
The study was also selected for inclusion in the Obstetrics & Gynecology Journal Club, which selects two to three studies per issue to provide medical students an opportunity to review landmark papers and help them build a foundation for evidence–based practice.
Between 6 million and 10 million health care visits by women in the U.S. are related to symptoms of vaginitis.1,2 Although vaginitis is a common condition, diagnosis of its usual causes3,4 (BV, VVC, or TV) in women of reproductive age is not standardized.
“A misdiagnosis means inappropriate treatment recommendations — either undertreatment or overtreatment,” said study co-author Molly Broache, medical science liaison for Integrated Diagnostic Solutions at BD. “A woman might be asked to make return visits to the doctor that aren’t necessary, or she may develop antimicrobial resistance because she’s taking antibiotics she doesn’t actually need.”
The study compared clinician diagnosis of vaginitis to results of a vaginal panel assay performed on the BD MAX™ System, an FDA-market authorized molecular test that uses nucleic acid amplification to detect the microbial causes of BV, VVC, and TV. The study involved 489 symptomatic participants. Participants received a clinical diagnosis and had a vaginal assay swab collected during their visit. Swabs were sent to a separate testing facility and later compared to clinician diagnosis.
“We really do women a medical disservice when we do not use the best tools we have available to diagnose the cause or causes of the symptoms that drove them to seek health care,” said study co-author Barbara Van Der Pol, Ph.D., MPH and Professor of Medicine and Public Health. “Too many infections are caused by multiple organisms for us to think that we can correctly identify them without high-quality diagnostic testing. The data in this paper confirms that we owe women the best options available and clinical observations are not sufficient.”
The BD MAX™ Vaginal Panel Assay can help address the limitations of clinical diagnosis and can help improve diagnostic accuracy. This automated assay has a shorter turnaround time (approximately three hours to run between two and 24 samples simultaneously), so same-day results are possible if the clinician has the instrument available on site. Assay automation is designed to decrease variability and subjectivity, thereby helping to increase diagnostic accuracy.
“When a woman is misdiagnosed either way — told that she doesn’t have vaginitis but actually does or told that she does have vaginitis but is not infected — it creates hardship and risk,” said Broache. “Women deserve better.”