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Am Fam Physician. 2007;76(8):1224

Background: One of the most common reasons for office visits is vaginitis, with approximately 30 percent of cases caused by Candida species infection. The evaluation of women with possible vulvovaginal candidiasis consists of microscopy, saline solution wet mount, whiff test, pH determination, and Gram stain. Diagnosis of vulvovaginal candidiasis is complicated by a significant overlap in symptoms with other causes of vaginitis. It is usually determined by clinical presentation, physical examination findings, vaginal pH, and microscopic examination of discharge. In several studies, however, this approach identified only 50 to 80 percent of women who had yeast cultures positive for Candida species. Cultures do not provide a viable diagnostic test for this vaginitis because they are expensive and take up to seven days to provide definitive results. One alternative to yeast cultures is a rapid test for vaginal yeast that can be self-administered. Chatwani evaluated the use of a rapid vaginal yeast test in the diagnosis of vulvovaginal candidiasis.

The Study: The authors carried out a prospective evaluation of nonpregnant adult women with or without symptoms such as vaginal discharge, itching, irritation, or odor. An examination was performed and a vaginal sample obtained for a wet mount, yeast culture, and rapid yeast test. After the examination, each participant performed a self-administered rapid yeast sampling following the manufacturer's instructions. The main outcomes measured were the sensitivity, specificity, and positive and negative predictive values of the rapid vaginal yeast test.

Results: Of the 104 participants, 70 had symptoms. The sensitivity of the physician-performed rapid yeast test in women with or without symptoms was 73.1 percent, compared with 43.9 percent for the wet mount. The specificity for wet mount in the same group was 88.9 percent, compared with 79.4 percent for the rapid yeast test. The positive predictive values for both tests were similar, but the negative predictive value was higher for the rapid yeast test (82.0 versus 70.9 percent, respectively). The results for the patient-obtained rapid yeast test were similar.

Conclusion: The rapid yeast test can be used in the evaluation of women with symptoms of vaginitis. It may increase the accuracy of diagnosing vulvovaginitis and reduce the overuse of treatment. The authors add that the rapid yeast test is superior to microscopy in the diagnosis of vulvovaginitis.

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