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Women's Health

Vaginitis/Vaginosis

Labcorp is your source for information and diagnostic support as you help manage your symptomatic patients.

NuSwab® Comprehensive Portfolio

Patient Evaluation

During their lifetime, the majority of women will have a vaginal infection, characterized by discharge, itching, burning or odor. With the availability of complementary and alternative therapies and over-the-counter medications for candidiasis, symptomatic women often seek these products before or in addition to an evaluation by a medical provider.1

Evaluation of patients with vaginitis symptoms should include a focused history. Patients may have difficulty distinguishing vulvar and vaginal symptoms. It is important to elicit information about the location of symptoms (vulva, vagina, anus) description of symptoms, and duration of symptoms. The clinician should inquire about the following to yield important insights into the likely etiology:2

  • Sexual history
  • Self-treatment with over-the-counter medication or prescription medications
  • Vulvovaginal hygiene practice
  • Relation of symptoms to the menstrual cycle
  • Underlying medical conditions

In settings where pH paper, KOH and microscopy are unavailable, a broad range of clinical laboratory tests, described in the diagnosis section for each disease, can be used.1

According to the CDC 2021 Sexual Transmitted Treatment Guidelines 

Empowering symptomatic women – Importance of healthcare provider intervention

Vaginitis has a broad differential diagnosis, and successful treatment frequently rests on an accurate diagnosis. The most common cause of vaginitis include vulvovaginal candidiasis, bacterial vaginosis and trichomoniasis.2

Bacterial Vaginosis

Bacterial vaginosis (BV) is the most common cause of vaginal symptoms among women, but it is not clear what role sexual activity plays in the development of BV.

Based on a nationally representative sample of women who participated in NHANES 2001-2004 the U.S. BV prevalence is estimated to be 21.2 million among women 14-49 and 60% are likely to see it return in 12 months.  

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  • Learn more about bacterial vaginosis

    What women are saying4

    80%

    women state BV symptoms make them feel uncomfortable in social settings

    50%

    women notice symptoms like changes in discharge or order

    95%

    women say that BV affects some aspect of their sex life

    Women with bacterial vaginosis are at an increased risk of various infections of the female reproductive track including:2

    • Pelvic inflammatory disease
    • Post-procedural gynecologic infections
    • Increased susceptibility to sexually transmitted infections (STIs) such as HIV and herpes simplex virus type

    Diagnostic Considerations for Bacterial Vaginosis:1

    • Nucleic acid amplification tests (NAAT) for BV should be used among symptomatic women only (e.g., women with vaginal discharge, odor or itch ).
    • Cervical Pap tests have no clinical utility for diagnosing BV because of their low sensitivity and specificity.
    • All women with BV should be tested for HIV and other STIs.

Vulvovaginal Candidiasis

Vulvovaginal candidiasis (VVC) is usually caused by Candida albicans but can occasionally be caused by other Candida species or yeasts.

An estimated 75% of women will have at least one episode of VVC, and 40%–45% will have two or more episodes. Approximately 10%–20% of women will have complicated VVC, requiring special diagnostic and therapeutic considerations.1

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  • Learn more about vulvovaginal candidiasis

    Typical symptoms of VVC include:1

    • Pruritus
    • Vaginal soreness
    • Dyspareunia (painful intercourse)
    • External dysuria
    • Abnormal vaginal discharge

    None of these symptoms is specific for VVC.1

    Diagnostic Considerations for Vulvovaginal Candidiasis: 

    VVC is often associated with abnormal discharge. However, VVC cannot be reliably diagnosed based on clinical symptoms alone.1 

    Vaginal culture or PCR should be obtained from women with complicated VVC to confirm clinical diagnosis and identify non-albicans Candida, as they are not easily recognized by microscopy. Culture and susceptibility testing should be considered for patients who remain symptomatic.1

    Pap tests are not reliable for diagnosing VVC, and diagnostic confirmation is recommended for incidental findings of VVC.2 

Trichomoniasis

Trichomoniasis, caused by infection with Trichomonas vaginalis, is estimated to be the most prevalent nonviral STI worldwide.1

Trichomoniasis causes reproductive morbidity and has been reported to be associated with preterm birth, premature rupture of membranes and infants who are small for gestational age.1 

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  • Learn more about trichomoniasis

    Did you know?

    1. 3.7M persons affected in United States 
    2. 2.1% prevalence in females
    3. 0.5% prevalence in males 
    4. Rates high women aged >24 as they are for women aged <24 years 
    5. Majority of persons who have trichomoniasis either have minimal or no genital symptoms

    Diagnostic Considerations for Trichomoniasis

    Testing for trichomoniasis should be performed for women seeking care for vaginal discharge.  Annual screening might be considered for persons receiving care in high-prevalence settings and for asymptomatic women at high risk for infection.1

    NAATs are highly sensitive, detecting more trichomoniasis infections than wet-mount microscopy among women.1

    People with trichomoniasis should be tested for other STIs including HIV, syphilis, gonorrhea, and chlamydia.1 Due to high rate of reinfection among women treated for trichomoniasis, retesting is recommended for all sexually active women.1 All sex partners of someone who has tested positive for trichomoniasis should receive concurrent treatment to prevent reinfections.1

nuSwab

Managing your symptomatic patient

Multiple diagnostic methods are available for identifying the etiology of vaginal symptoms. Clinical laboratory testing can identify the vaginitis cause in the majority of women.1

NuSwab® Comprehensive Portfolio 

It has been reported that overall diagnostic accuracy was approximately 20% to 25% higher for NuSwab VG vs. BD Affirm™ when modeled in populations with 30% or greater prevalence of infectious vaginitis.

Key findings:5

For the past decade, our NuSwab testing portfolio has offered physicians a non-subjective, cost-effective and clinically relevant means to diagnose millions of symptomatic patients with vaginitis/vaginosis. Our profiles have been developed to maximize sensitivity and specificity, allow providers to detect the underlying cause of a woman’s BV-like symptoms and treat her accordingly.

Bacterial (BV)

NuSwab sensitivity/specificity - 96.9%/92.6%
BD Affirm sensitivity/specificity - 90.1%/67.6%

Fungal (Candida)

NuSwab sensitivity/specificity - 97.7%/93.2%
BD Affirm sensitivity/specificity - 58.1%/100%

Parasitic (Trichomonas vaginalis)

NuSwab sensitivity - 98.1%
BD Affirm sensitivity - 46.3%

View additional resources

References

1. Sexually Transmitted Infections Treatment Guidelines, 2021. https://www.cdc.gov/std/treatment-guidelines/default.htm. Accessed July 29, 2021.

2. American College of Obstetricians and Gynecologists. Vaginitis in Nonpregnant Patients. ACOG Practice Bulletin No. 215.Obstet Gynecol. Vol 135, NO.1, January 2020.

3. CDC Bacterial Vaginosis (BV) Statistics, 2020. https://www.cdc.gov/std/bv/stats.htm. Accessed March 22, 2022. 

4.  Bacterial Vaginosis Survey – Patients & Healthcare Professionals, Harris Insights & Analytics Survey conducted September 14-29, 2017, (https://www.keepherawesome.com/bacterial-vaginosis); Accessed March 22, 2022.

5. Cartwright CP, Lembke BD, Ramachandran K, Body BA, Nye MB, Rivers CA, Schwebke JR. Comparison of Nucleic Acid Amplification Assays with BD Affirm VPIII for Diagnosis of Vaginitis in Symptomatic Women. J Clin Micro. Nov 2013;51(11):3694-3699.