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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

Journal of Lower Genital Tract Disease: October 2007 - Volume 11 - Issue 4 - pp 240-250
doi: 10.1097/LGT.0b013e318033dfed
Original Articles
Spanish Translation

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.

The standard diagnostic tests for BV, vulvovaginal candidiasis, and trichomoniasis behave similarly in HIV-infected and HIV-seronegative women.

1Department of Medicine, Section of Infectious Diseases, Rush University Medical Center, Chicago, IL, 2Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, 3Department of Medicine, SUNY-Downstate Medical Center, Brooklyn, NY, 4Department of Pathology, University of California, San Francisco, CA, 5Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles, CA, 6Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 7Department of Epidemiology and Population Health, Montefiore Medical Center, Bronx, NY, 8Departments of Obstetrics and Gynecology and Medicine, University of Virginia Health Sciences System, Charlottesville, VA, 9The CORE Center at John H. Stroger Jr. Hospital of Cook County, Chicago, IL, and 10Pediatric, Adolescent, and Maternal AIDS Branch CRMC/NICHD, Bethesda, MD

Reprint requests to: Beverly E. Sha, MD, Suite 143, 600 S Paulina, Chicago, IL 60612. E-mail: bsha@rush.edu

This work was supported by the Women's Interagency HIV Study funded by the National Institute of Allergy and Infectious Diseases with additional funding from the National Cancer Institute, the National Institute on Drug Abuse (U01-AI-35004, U01-AI-31834, U01-AI-34994, U01-AI-34989, U-1-AI-34993, and U01-AI-42590), the National Institute of Child Health and Human Development (U01-HD-32632), and the National Center for Research Resources (M01-RR-00071, MO1-RR-00079, and M01-RR-00083). None of the authors have a commercial or other association that might pose a conflict of interest.

We dedicate this manuscript to the memory of our colleague, Dr. Douglas Passaro, taken from us too soon.

©2007The American Society for Colposcopy and Cervical Pathology