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Tamara Ooms, RN, MS, FNP-C

Tamara Ooms, RN, MS, FNP-C

Medical Science Liaison (MSL), Cepheid

Lecture de 6 m

16 septembre 2026

LA SANTÉ COMMUNAUTAIRE ET MONDIALE

Perspective d’expert

Expert Q&A: What a New Study Reveals About Vaginal Infection Diagnosis

Bacterial vaginosis is difficult to diagnose: symptoms are non-specific and usual diagnostic methods have limitations. Hillier and colleagues5 suggest that point-of-care nucleic acid amplification testing (POC NAAT) could improve diagnostic accuracy and reduce unnecessary treatment vs usual care

To put these findings in context, we spoke with Tamara Ooms, RN, MS, FNP-C, who is not an author of this study but has focused on Women’s and Sexual Health as a Medical Science Liaison at Cepheid and in her prior healthcare roles.

Q : Let's start at the beginning. Why is diagnosing vaginal infections so difficult?

A : In short, because symptoms can be misleading. Many women present with discharge, odor, itching, or discomfort, but these are often poor indicators of an infection.1 Two women can have the same symptoms, yet only one might have an infection — and based on symptoms alone, it’s hard to tell which, if either, does.

Q : And this lack of precision presumably leaves women at risk of not being properly treated?

A : Exactly. If infections are missed, women can miss out on appropriate treatment and symptom relief, which is a problem. Bacterial vaginosis and Trichomonas vaginalis infection are linked with things like an increased risk of sexually transmitted diseases or even pregnancy complications.2–4

And when women without infection are treated with antibiotics, “just in case”, it can expose women to avoidable side effects, disrupt the natural balance of bacteria in the vagina and contribute to antimicrobial resistance.5

Q : That’s potentially a big problem, especially given vaginitis can affect nearly a third of U.S. women.2 Surely, guidelines address this?

A : They try to. Clinical guidelines recommend tests like vaginal pH measurement, the whiff test (KOH), or microscopy.6 In theory, these help clinicians move beyond symptoms alone.

Q : And in practice?

A : They’re often unavailable, inconsistently used, or as is often the case with microscopy, limited by low sensitivity.7

Q : So where does the new study come in?

A : In a randomized controlled trial involving over 270 women, U.S. researchers compared usual care diagnosis with diagnosis using Xpert® Xpress MVP, a point-of-care nucleic acid amplification test (NAAT).5

They wanted to see how many women would receive the appropriate CDC-recommended or FDA-approved treatment within 24 hours of a clinic visit. To put it another way, they wanted to see if Xpert Xpress MVP increased the likelihood that women received the correct treatment compared with usual care.

Q : Did this test improve the likelihood of correct treatment?

A : Yes. And quite dramatically so. 89,6% of women with a diagnosed infection in the NAAT group received the appropriate treatment, while only 51,9% in the usual care group did.5

Q : That’s a big gap. Was it consistent across different infections?

A : It was. For bacterial vaginosis, appropriate treatment was seen in 56% of women with usual care, compared to over 91% in the NAAT group. For Candida infections, the difference was 55% appropriate treatment with usual care vs nearly 96% for women diagnosed with NAAT.5

Q : That suggests many women under usual care were incorrectly treated, or treated unnecessarily?

A : Unfortunately, yes. One of the big learnings from this study was that usual care often results in prescribing medication for women who did not need it. Half of women with no pathogens in the usual care group were given unnecessary medications, compared with less than a third in the NAAT group.

Q : Why did a third of NAAT-tested women still get prescribed unnecessary medications?

A : The researchers suggested it may have been due to clinicians wanting to meet a patient’s request for treatment, missing the result in the electronic record, or not fully trusting the test.5 It goes to show, testing technology alone isn’t going to fix overprescription. Results still need to be trusted, integrated into workflows, and supported by clear conversations with patients about why antibiotics or antifungals may not be appropriate when no pathogen is detected.

Q : So, what did clinicians make of point-of-care NAAT after using it?

A : At the start of the trial, most clinicians (86%) were confident in the standard diagnostic methods they were already using.5 By the end of the study, the majority had a high opinion of point-of-care NAAT: 98% were satisfied with the 1-hour turnaround and 87% wanted to adopt the method.5 An important finding in terms of integration into routine practice was that non-laboratory staff were able to perform the tests after only brief training.5

Q : Does this make a case for integrating NAAT testing into standard care?

A : The findings certainly show that technology like Xpert Xpress MVP has the potential to help. The unmet need is clear. These findings were similar to an earlier study showing that usual care in community practice led to inappropriate treatment in about 40% of women.8 And those women who received unnecessary treatment were significantly more likely to return with vaginitis symptoms within 3 months than those who weren’t treated (22% vs 6%).8

Q : Any study limitations we should keep in mind?

A : The authors mention a few. The low prevalence of trichomoniasis in the study population (in only 5% of women) limited meaningful statistical comparisons for treatment appropriateness.5

What’s more, there was only a 1-month follow-up, so researchers couldn’t assess if the high rates of inappropriate treatment with usual care led to more visits for persistent symptoms.

Q : What’s the take-home message for healthcare professionals?

A : The study suggests healthcare providers should prioritize point-of-care NAAT testing for women with vaginal symptoms, when available. Moving away from relying on symptom-based care and traditional diagnostic methods can improve diagnostic accuracy, increase appropriate treatment, reduce unnecessary antibiotics, and better address one of the most common women's health concerns.

Speaker Bio

Tamara Ooms, RN, MS, FNP-C, is a Medical Science Liaison at Cepheid, focused on Women’s and Sexual Health as well as virology. She is a nurse practitioner who is passionate about delivering effective solutions to improve healthcare services and clinical outcomes.

 

This study5 was conducted with support from Cepheid.

IVD. In vitro diagnostic medical device. Pourrait ne pas être disponible dans tous les pays.

Le contenu présenté sur cette page est destiné à des fins informatives et éducatives. Bien qu’il soit disponible à l’échelle mondiale, il peut refléter des pratiques cliniques ou des enjeux en matière de système de santé propres à une région particulière.

Références

1.      Landers DV, et al. Predictive value of the clinical diagnosis of lower genital tract infection in women. Am J Obstet Gynecol 2004;190:1004–10.

2.      Koumans EH, et al. The prevalence of bacterial vaginosis in the United States, 2001-2004: associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis 2007;34:864–69.

3.      Cotch MF, et al. Trichomonas vaginalis associated with low birth weight and preterm delivery. Sex Transm Dis 1997;24:353–60.

4.      Mohanty T et al. Effect of bacterial vaginosis on preterm birth: a meta-analysis. Arch Gynecol Obstet 2023;308:1247–55.

5.      Hillier SL, et al. Randomized Study of Usual Care vs Xpert® Xpress MVP at the Point of Care for Accurate Diagnosis and Appropriate Treatment of Vaginal Infections. Sexually Transmitted Diseases ():10.1097/OLQ.0000000000002343, 12 mai 2026. | DOI: 10.1097/OLQ.0000000000002343 Sexually Transmitted Diseases

6.      Centers for Disease Control and Prevention. 2021. Lignes directrices sur le traitement des maladies sexuellement transmissibles, 2021. Morbidity and Mortality Weekly Report 70(4).

7.      Nyirjesy P, et al. Physician awareness and adherence to clinical practice guidelines in the diagnosis of vaginitis patients: a retrospective chart review. Popul Health Manag 2020;(S1):S13–S21.

8.      Hillier SL, et al. Diagnosis and treatment of vaginal discharge syndromes in community practice settings. Clin Infect Dis 2021;72:1538–43.

 

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