Commentary

Common, non–life-threatening problems are often the least studied areas of medicine, despite the overall burden of disease that they cause. At last, we are beginning to accumulate evidence to guide diagnosis and management in these areas. The review by Anderson et al presents a summary of the available evidence on the accuracy of the symptoms, signs, and office laboratory tests for diagnosing vaginal complaints.

With the exception of white curdy discharge, which helps to rule in the diagnosis of VC; yellow discharge, which can indicate the presence of either BV or VT; and redness or oedema, which can also indicate VT, these symptoms and signs are only moderately helpful in determining whether a patient has any of these vaginal conditions. The absence of symptoms and signs is even less helpful in ruling out disease, with only the absence of odour or yellow discharge ruling out BV. Office laboratory tests perform better because they rule in the disease if they are positive, but they do not rule out the disease if they are negative. Furthermore, many clinicians do not have the skills, time, or equipment to use these tests.

Several questions remain after reading this review: Could there be combinations of symptoms and signs that might better rule in or rule out the diagnosis? How does this information combine with more definitive testing, such as culture of a high vaginal swab? What is the treatment threshold for these conditions? Might it be better to treat on clinical suspicion, and test only those patients who fail a course of treatment? Primary care gynaecology requires more research to guide clinical decision making in this area.