Test	Bacterial vaginosis	Trichomoniasis	Vulvovaginal candidiasis	Cost*
Point-of-care tests*
Amsel criteria	Sensitivity, 69%; specificity, 93%	NA	NA	$$
pH	pH > 5: sensitivity, 77%; specificity, 35%	pH > 5.4: sensitivity, 92%; specificity, 51%	pH < 4.9: sensitivity, 71%; specificity, 90%	$
Whiff test (the amine odor produced by mixing 10% potassium hydroxide solution with a sample of vaginal discharge)	Positive test: sensitivity, 67%; specificity, 93%	Positive test: sensitivity, 67%; specificity, 65%	Negative test	$
Fem Exam card (Cooper Surgical, Shelton, Conn.) Two colorimetric strips: card 1 measures pH and amine levels; card 2 measures proline aminopeptidase activity	Cards 1 and 2 combined: sensitivity, 91%; specificity, 61%	NA	NA	$$
	Rapid (two minutes), less subjective than whiff test, easily performed
Microscopy (with 10% potassium hydroxide solution, saline)	Clue cells, bacilli with corkscrew motility, scant or absent lactobacilli	Motile protozoa with flagella; more leukocytes than epithelial cells	Budding filaments, mycelia with 10% potassium hydroxide solution	$
	Sensitivity, 53 to 90%; specificity, 40 to 100%	Sensitivity, 50 to 70% (may be increased by vaginal lavage to 74%); specificity, 100%	Sensitivity, 61%; specificity, 77%
pH, trimethylamine card (QuickVue Advance Quidel, San Diego, Calif.)	Sensitivity, 53%; specificity, 97%	NA	NA	$
	Rapid, simple, comparable with pH and whiff test
Proline aminopeptidase card (Pip Activity TestCard, Litmus Concepts, Inc., Santa Clara, Calif.) Indirect test for a chemical produced by the organisms associated with bacterial vaginosis	Sensitivity, 70%; specificity, 81%	NA	NA	$
	Rapid, simple, comparable with Fem Exam card 2
OSOM Trichomonas Rapid Test (Genzyme Diagnostics, Cambridge, Mass.), uses color immunochromatographic “dipstick” technology with murine monoclonal antibodies	NA	Sensitivity, 90 to 100% 10 minutes to complete test	NA	$$$
BD Affirm VPIII Microbial Identification Test (BD Diagnostic Systems, Sparks, Md.)	Sensitivity, 95 to 100% 45 minutes to complete test	Sensitivity, 90 to 100%	Sensitivity, 90 to 100%	$$$
		False-positive results may occur, especially in low-prevalence groups
Polymerase chain reaction: based on DNA amplification (Quest Diagnostics, Madison N.J.), Instagene Matrix (Bio-Rad Laboratories, Hercules, Calif.)	Effective at identifying bacteria responsible for bacterial vaginosis	Sensitivity, 80%; specificity, 97%	Polymerase chain reaction more sensitive than culture in detecting Candida; not yet commercially available as a diagnostic test	$$$
Reference laboratory testing*
Culture	Predictive value of a positive Gardnerella vaginalis culture is less than 50%; generally not recommended, but may have value in recalcitrant cases	InPouch Culture System (Biomed, White City, Ore.)	Positive culture alone does not necessarily indicate that the yeast identified are responsible for vaginal symptoms	$$$
		Combined wet-mount preparation and culture kit; can be kept at room temperature for up to 18 hours; samples taken during menses were not adversely affected
		Sensitivity, 81 to 100%
Patient-performed tests
Over-the-counter test for vaginal infections (Fem-V; Synova Healthcare, Inc., New York, NY)	Positive test suggests possibility of bacterial vaginosis and need for physician visit (20% false-positive rate)	Positive test suggests possibility of trichomoniasis and need for physician visit (20% false-positive rate)	Negative test suggests possibility of yeast infection	$
			Over-the-counter antifungal treatment recommended (10% false-negative rate)
Over-the-counter rapid yeast detection test (Savyon Diagnostics, Ashdod, Israel): uses the concept of lateral flow immunoassay systems	NA	NA	Positive test: sensitivity, 73%; specificity, 84%	$
			Patient-performed tests have results similar to physician-performed tests
			Negative test: not sensitive enough to rule out yeast infection and avoid a culture