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Literature reviews > Articles for review > Kissinger et al. Vaginal swabs versus lavage... |
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The agreement between cervicovaginal lavages and vaginal swabs for T. vaginalis and bacterial vaginosis detection was excellent. Vaginal swabs versus lavage for
detection of Trichomonas vaginalis and bacterial vaginosis among
HIV-positive women. Question Design The sensitivity of CVL was compared with that of vaginal swabs for detection of T. vaginalis using wet mount and of BV using clinical criteria. The performances of both specimen collection methods were compared with culture for T. vaginalis and Gram stain score for BV detection.Participants Two hundred sixteen women at least 18 years old who were HIV-positive and attending an HIV out patient clinic in New Orleans were tested. The women were a subset of a larger cohort study to examine multiple issues of STIs and HIV among women. The mean age was 36.1 years, 88.2% were black, 65.1% of the women douched.Description of Tests and Diagnostic Standard During a nonlubricated speculum examination, 4 vaginal swabs and 5 cc of vaginal saline lavage fluid were obtained. The swabs and lavages were used to prepare a Gram stain, inoculate an InPouch TV culture, prepare a wet mount, measure the pH, and perform the whiff test. The wet mounts were examined for motile trichomonads and clue cells. The Gram stains were scored for BV according to the Nugent criteria. Women were positive for T. vaginalis if the InPouch TV culture was positive at or before 72 h after inoculation. Women were positive for BV if the Gram stain score was >7.Main Outcome Measures The clinical diagnosis of trichomoniasis by wet mount and BV by Amsel criteria using CVL and vaginal swab specimens were compared with the laboratory diagnosis by InPouch TV culture and Nugent Gram stain score.Main Results The prevalence of T. vaginalis was 25.0% by InPouch culture and 18.9% and 13.3% by wet mount using CVL and vaginal swabs, respectively. The prevalence of BV was 49.3% by Gram stain score and 20.2% and 18.4% by clinical criteria using CVL and vaginal swabs, respectively. The performances of wet mount compared to culture for T. vaginalis and Amsel criteria compared to Gram stain score for BV detection using CVL and vaginal swabs are shown in the table. The sensitivity of CVL was significantly better than that of vaginal swabs for detection of T. vaginalis by wet mount (p<0.04). Performance of cervicovaginal lavage (CVL) and vaginal swab specimens for detection of T. vaginalis by wet mount compared to culture and for detection of BV by Amsel criteria compared to Gram stain score among 216 HIV-positive women
Source of funding: None given For correspondence: Patricia J. Kissinger, Tulane University Medical Center, Department of Epidemiology (SL-18), 1440 Canal Street, New Orleans, LA 70112. E-mail address: kissing@tulane.edu |
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