Vaginal discharge: risk assessment and predictive value of cytologic smears and culture

Objectives : To evaluate the risk factors associated with vaginal discharge and the predictive value of cytologic smears and cultures in its clinical diagnosis. Methods : This is an observational study. One hundred fifty consecutive women presenting for the first time to the Gynecology outpatient clinic of a Medical College hospital with complaints of vaginal discharge, lower abdominal pain and genital warts or ulcers were enrolled over a period of 4 months. Specimens were collected for laboratory investigation to aid in the etiological diagnosis of vaginal discharge. A risk factor assessment was performed. Results : Univariate analysis of selected risk factors with three vaginal infections did not show any significant association between sociodemographic indicators and the occurrence of infection. Bacterial vaginosis (BV) was the most common pathogen associated with HIV seropositivity. Using greenish yellow frothy discharge and strawberry vagina as a clinical sign for the diagnosis of trichomoniasis, the sensitivity of detection was 68.8% with PPV and NPV exceeding 90%. When curdy white discharge was used as a clinical sign for candidiasis, the sensitivity was 61.9% and specificity 99.1%. Conclusions: Syndromic management of vaginal discharge based on appearance and characteristics is likely to be more accurate in case of greenish yellow frothy and curdy white discharge as compared to homogeneous white discharge.