Improving Vaginitis Care Through Better Diagnostics

Real-world evidence supports informed treatment for vaginitis

Vaginitis—including bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomoniasis (TV)—is among the most common reasons women seek care from primary care providers or Ob/Gyns in the U.S.¹ Although treatable, these infections can be recurrent and may lead to serious complications if misdiagnosed or improperly managed.

Accurate diagnosis is the cornerstone of effective treatment. Yet a recent study published in Sexually Transmitted Diseases ² reveals a troubling trend: empiric treatment —initiating therapy without test results— is widespread and frequently inconsistent with confirmed diagnoses, particularly in cases involving co-infections.

The study’s findings make one thing clear: fast, accurate diagnostics at the point of care are essential to improving vaginitis treatment outcomes.

What is Vaginitis?

Vulvovaginitis (or just “vaginitis”) is a spectrum of conditions that cause various vaginal or vulvar symptoms including inflammation, itching, burning, pain, odor, and vaginal discharge. The most common causes of vaginitis are:^3.4

• Bacterial vaginosis (BV)
• Vulvovaginal candidiasis (VVC)
• Trichomoniasis (TV)

If improperly managed, vaginitis is associated with severe harm, including pregnancy complications, pelvic inflammatory disease, and increased risk of contracting and transmitting HIV and other STI⁵

The study² demonstrates the following:

Empiric Treatment is Alarmingly Common

The retrospective study analyzed data from electronic medical records and claims from 2018 to 2023, focusing on how women—both pregnant and non-pregnant—with vaginitis symptoms were tested and treated. Diagnostic methods included traditional approaches (e.g., wet mount microscopy, vaginal pH, culture, Gram stain followed by Nugen score analysis, Amsel criteria), direct probe tests, and multiplex nucleic acid amplification tests (NAATs).

Results revealed that empiric treatment is widespread across all testing methods and in both pregnant and non-pregnant women. Among all patients who received any therapy, 35,5-74,3% were empirically treated and 36,4-72% received informed treatment. This suggests that many healthcare providers are prescribing treatment based on symptoms alone, before having definitive diagnostic information.

Empiric Treatment Often Misses the Mark, Especially with Co-infections:

Even more concerning is that these empiric treatments frequently didn't align with the actual infection identified by subsequent testing. For example, 6.5-8.2% of pregnant and 11,7-13% of non-pregnant patients who tested positive for BV via NAAT panel or direct probe received empiric treatment intended for VVC (antifungals).

The risk of inappropriate treatment was even greater in patients with co-infections. Among pregnant women who tested positive for both BV and VVC via direct probe, ~23% received treatment that addressed only one or neither of the infections. These findings underscore the limitations of symptom-based prescribing, especially when multiple pathogens are involved.

Informed Treatment Shows Promise, But Delays Can Occur

On a more positive note, the study found that treatment was largely appropriate when informed by positive test results. In the non-pregnant cohort, 96-100% of those who tested positive for BV and 82–89% of those positive for VVC received appropriate therapy. Similar findings were observed in the pregnant cohort.

However, the study also noted delays in treatment initiation, including among those with positive TV results. Some patients with positive test results did not have recorded treatment within a week of diagnosis, while others did not have any recorded vaginitis treatments. This points to potential gaps in follow-up care that may contribute to prolonged symptoms, transmission of TV to sexual partners, and increased risk of complications.

The Path Forward: Rapid, Accurate Point-of-Care Diagnostics

The study supports a shift toward rapid, multiplex NAATs capable of detecting multiple pathogens simultaneously at the point of care. Unlike traditional methods, which are often insensitive and miss co-infections, and lab-based NAATs with 1 to 3-day turnaround times, point-of-care multiplex NAATs can provide actionable results during the patient visit.

Point-of-care multiplex NAATs enable accurate and rapid diagnosis and could improve diagnostics-guided prescribing. Reducing empiric treatment may lower rates of persistent or recurrent infection and help combat antimicrobial resistance.

Embracing rapid, point-of-care diagnostic technologies is not simply a matter of convenience; it’s essential to delivering effective, personalized care. For women experiencing vaginitis symptoms, the ability to receive the right treatment at the right time can make a significant difference in health outcomes and quality of life.

Ready to Advocate for Point-of-Care Vaginitis NAAT Testing?

Healthcare providers and administrators can use the following talking points to advocate bringing point-of-care NAAT testing to their facility

• Improved Diagnostic Accuracy: Multiplex PCR technology allows for the detection and differentiation of the most common causes of vaginitis, including co-infections, leading to more targeted and effective treatment.
• Reduced Return Visits: By providing accurate results at the point of care, you can facilitate appropriate treatment the first time, potentially reducing rates of repeat visits.
• Enhanced Antibiotic Stewardship: Targeted therapy based on accurate diagnosis can minimize the inappropriate use of treatments, contributing to efforts to combat antimicrobial resistance.
• Potential to Improve Patient Quality of Life: Fast, accurate diagnostic testing at the point of care has the potential to reduce misdiagnosis and mistreatment that can lead to negative health outcomes including the acquisition and forward transmission of STIs and adverse birth outcomes.