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A comparative study of clinical management strategies for vaginal discharge in family planning and genitourinary medicine settings
  1. Catriona Melville, MRCOG, DFFP, Specialist Registrar in Obstetrics and Gynaecology, West of Scotland Region1,
  2. Rak Nandwani, FRCP, DFFP, Associate Director and Consultant in HIV/Genitourinary Medicine1,
  3. Alison Bigrigg, PFFR, FRCS, Director and Consultant in Community Gynaecology1 and
  4. Alex D McMahon, PhD, Senior Statistician2
  1. The Sandyford Initiative, Glasgow, UK
  2. Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
  1. Correspondence to Dr Catriona Melville, The Sandyford Initiative, 2–6 Sandyford Place, Sauchiehall Street, Glasgow G3 7NB, UK. Tel: +44 (0) 141 211 8130. Fax: +44 (0) 141 211 8149. E-mail: catrionamelville{at}tiscali.co.uk

Abstract

Objective To compare strategies for management of women with vaginal discharge in genitourinary medicine (GUM) and family planning (FP) settings.

Methods The setting was a centre housing both FP and GUM departments within a primary care trust in Scotland. The study participants were 200 women presenting with vaginal discharge. A randomised, controlled, crossover design was employed. Strategies typical of FP and GUM were performed on every participant in a randomised sequence. Day 1 diagnoses were made by the FP strategy (history and examination) and the GUM strategy (nearpatient microscopy added). Day 7 results were obtained from final analysis of all specimens. Days 1 and 7 results were compared with the reference standard provided by all the test results. The main outcome measures were incorrect diagnoses on Days 1 and 7.

Results On Day 1 the FP strategy resulted in significantly more incorrect diagnoses than the GUM strategy when compared with the reference standard (73 vs 32; p <0.001). On Day 7 the GUM strategy resulted in significantly more incorrect diagnoses than the FP strategy when compared with the reference standard (32 vs 17; p = 0.019).

Conclusions Vaginal discharge can be managed effectively in community settings such as FP and primary care. The addition of near-patient microscopy produces a more accurate immediate diagnosis. The addition of a high vaginal swab for culture produces a more accurate final diagnosis. The costs of on-site microscopy must be considered.

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  • Accepted July 23, 2004.

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