Predictive value of the clinical diagnosis of lower genital tract infection in women

Daniel V. Landers, Harold C. Wiesenfeld, R. Phillip Heine, Marijane A. Krohn, Sharon L. Hillier, Ronald Gibbs

Research output: Contribution to journalArticlepeer-review

131 Scopus citations


Objective: We hypothesized that diagnostic approaches to lower genital tract infections are inaccurate and proposed this study to evaluate typical approaches. Study design: Clinical diagnoses were made with symptoms, direct observation, wet mount, vaginal pH, and amines in 598 women with genital complaints. Laboratory testing for N gonorrhoeae, yeast, T vaginalis, C trachomatis, and bacterial vaginosis by Gram stain. Results: The most frequent symptoms were vaginal discharge (64%), change in discharge (53%), malodor (48%), and pruritis (32%). The infection rates were 46% bacterial vaginosis, 29% yeast, 12% trichomoniasis, 11% chlamydia or gonorrhea; 21% of the patients had no infection. The symptoms did not predict laboratory diagnosis. Clinical signs and symptoms with office-based tests and microscopy improved the accuracy of diagnoses. Amsel's clinical diagnosis of bacterial vaginosis was the most sensitive at 92%. The sensitivity of wet mount diagnosis of trichomoniasis was 62%, of yeast by microscopy was 22%, and of mucopus for the prediction of gonorrhea and/ or chlamydia was 30%. Conclusion: Symptoms alone should not be used to direct treatment in instances in which resources permit more complete evaluation with office-based testing that includes microscopy. Treatment failures or diagnostic uncertainty should prompt specific laboratory testing.

Original languageEnglish (US)
Pages (from-to)1004-1008
Number of pages5
JournalAmerican journal of obstetrics and gynecology
Issue number4
StatePublished - Apr 2004


  • Bacterial vaginosis
  • Lower genital tract infection
  • Trichomoniasis
  • Vaginalis
  • Yeast vaginitis


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