Vaginal discharge

Culture and wet smear microscopy in the diagnosis of low-symptomatic vulvovaginal candidosis

OBJECTIVES

To compare the clinical usefulness of culture and wet smear microscopy in low-symptomatic vulvovaginal candidosis (VVC) diagnosis.

STUDY DESIGN

Women attending for contraceptive advice were screened for vaginal yeast fungi by culture and wet smear microscopy. A positive culture was found in 130 (13.2%) of the 983 women studied, while a positive wet smear was found in 133 (13.9%). In 40 (30%) of these women both the culture and wet smear was positive.

RESULTS

The methods were equally sensitive in predicting symptoms of VVC, such as pruritus, smarting and burning pain, as well as for dyspareunia (35% vs. 36%), but wet smear microscopy was more sensitive in predicting signs of VVC, such as erythema and abnormal discharge (52% vs. 34%). The highest sensitivity was reached when both methods were positive (60% for symptoms, 75% for signs). There was no quantitative correlation between number of Candida colonies on culture on the one hand and symptoms, signs or a positive wet smear on the other hand. Using four parameters as a diagnostic battery for VVC, the two methods complemented each other. The correlation between symptoms and/or signs for wet smear was high than for culture.

CONCLUSION

Wet smear microscopy of vaginal secretion, along with signs found at examination, should be the first-line test in the diagnosis of VVC. Culture must, however, be used when there is a clinical suspicion of VVC and a negative wet smear, or when speciation or antibiotic susceptibility tests of isolates are required.

The diagnosis of candida vaginitis in general practice

In a multi-practice study, 29 general practitioners registered 361 women with increased vaginal discharge, malodour, or pruritus, and 229 women without vaginal complants. A wet-smear was examined for Candida by the general practitioner. Culture for Candida was performed in the general practitioner's laboratory, and at a microbiological laboratory. Candida was found by microscopy or culture in 140 (39%) women with vaginal symptoms, compared with 51 (22%) without vaginal complaints (p less than 0.001). In 34 women with symptoms (24%) Candida was found by wet-smear microscopy, in 98 (76%) by microscopy or culture in the general practitioner's laboratory, and in 126 (90%) by microscopy or culture at the microbiological laboratory. No relation was found between the number of Candida isolated and the presence of vaginal symptoms (p greater than 0.05). The sensitivity of microscopy was low compared with previous studies and underlines the need for multi-practice studies in the evaluation of diagnostic procedures. Vagicult is recommended for general practice, but problems exist in the interpretation of a positive culture result.