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4. Comparison of visual, clinical and microbiological diagnosis of symptomatic vaginal discharge in the reproductive age group

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Author(s): S. Rekha | S. Jyothi

Journal: International Journal of Pharmaceutical and Biomedical Research (IJPBR)
ISSN 0976-0350

Volume: 01;
Issue: 04;
Start page: 144;
Date: 2010;
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Keywords: Symptomatic vaginal discharge | Syndromic management | Blanket therapy

ABSTRACT
In the present study, the inaccuracies of visual or presumptive clinical diagnosis of the causative agent of vaginal discharge were investigated. Further it was examined whether the addition of simple microscopic techniques such as wet smear and Gram stain can aid accurate diagnosis of this common condition. Also the accuracy of the WHO syndromic approach and the blanket therapy advocated by this approach was evaluated. This is a prospective study done over a period of one year. 203 women with symptomatic vaginal discharge were evaluated by the visual, clinical and microbiological diagnostic methods and compared. Etiological diagnosis was obtained in 146 patients (72%) included and in the remaining 57 (28%) of the patients etiological cause could not found. Visual approach diagnosed and treated 38.5% of the cases as bacterial vaginosis and 9% as candidiasis with no microbiological evidence of infection whereas 6% of cases with confirmed microbiological diagnosis of trichomoniasis were missed out on visual diagnosis and were not treated. If blanket therapy is given to all women complaining of abnormal vaginal discharge then, 44% of the women would receive antibiotics and 84% antifungal treatment unnecessarily. For the etiological diagnosis of symptomatic vaginal discharge, the most ideal approach is the microbiological approach. Blanket therapy based on the WHO algorithm in patients with symptomatic vaginal discharge has limited advantage. In a resource constrained setting, at least a clinical diagnosis based on simple microscopy, pH and amine test and the WHO algorithm has to be made prior to treatment, to avoid diagnostic and treatment mismanagement.
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