Skip Navigation LinksHome > October 2007 - Volume 11 - Issue 4 > Analysis of Standard Methods for Diagnosing Vaginitis: HIV I...
Journal of Lower Genital Tract Disease:
doi: 10.1097/LGT.0b013e318033dfed
Original Articles

Analysis of Standard Methods for Diagnosing Vaginitis: HIV Infection Does Not Complicate the Diagnosis of Vaginitis

Sha, Beverly E. MD1; Gawel, Susan H. MS2; Hershow, Ronald C. MD2; Passaro, Douglas MD2; Augenbraun, Michael MD3; Darragh, Teresa M. MD4; Stek, Alice MD5; Golub, Elizabeth T. PhD6; MPH, Lorraine Cashin MD7; Moxley, Michael D. MD8; Weber, Kathleen M. BSN9; Watts, D. Heather MD10

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Objective. We sought to determine whether the standard diagnostic methods for vaginitis behave similarly among HIV-infected and at-risk seronegative women.

Materials and Methods. We performed pairwise comparisons over time (1994-2003) for the different diagnostic methods for bacterial vaginosis (BV) (Nugent score and Amsel criteria), vulvovaginal candidiasis (potassium hydroxide smear and Pap smear), and trichomoniasis (culture, wet mount, and Pap smear) among HIV-infected and at-risk HIV seronegative women in the Women's Interagency HIV Study cohort. We stratified subjects by HIV status and among the HIV-infected women by CD4+ cell count strata.

Results. For BV and trichomoniasis, κ statistics comparing clinical diagnostic methods to laboratory-based methods improved after the first year. Significant differences in overall κ statistics between HIV-infected and at-risk HIV-seronegative women were found only for vulvovaginal candidiasis where potassium hydroxide smear and Pap smear findings were more tightly correlated among HIV-infected women than among at-risk HIV-seronegative women; among these HIV-infected women, concordance was highest at lower CD4 cell counts. No significant differences in κ statistics were found for the diagnostic methods of BV or trichomoniasis neither by HIV status nor CD4+ cell count strata.

Conclusions. The standard diagnostic tests for BV, vulvovaginal candidiasis, and trichomoniasis behave similarly in HIV-infected and at-risk seronegative women. Training and experience are critical for the accurate performance of the diagnostic methods that require clinician interpretation.

©2007The American Society for Colposcopy and Cervical Pathology


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