Vaginal Woes Often Misdiagnosed

Study finds telephone calls less accurate than office visits, both not as certain as lab tests

THURSDAY, Jan. 3, 2002 (HealthDayNews) -- Women seeking medical help for vaginal infections should not rely on a telephone diagnosis.

That's the finding of a new study that compared the accuracy of diagnoses made over the phone with those made during office visits, and then measured both against laboratory findings.

"What we discovered is that the telephone should not be considered a diagnostic tool. There are too many variables involved, and women who rely only on a telephone diagnosis are not getting adequate care," says study author Dr. Jandel T. Allen-Davis.

Although the study clearly showed that telephone diagnosis was not nearly as accurate as an office exam, experts also warn that you shouldn't let your confidence level soar just because you've seen a doctor.

That's because the study also showed that a diagnosis made in the office was often incorrect when compared to cultures and lab test results.

"I think the bottom line here is that we need better in-office diagnostic measures if we are going to be successful at reducing the number of chronic vulvovaginal complaints," Allen-Davis says.

Although gynecologist Dr. Ernst Bartsich agrees on the need for better diagnostic tools, he's not so quick to dismiss the value of a telephone consultation, if it's done by someone who knows the patient.

"If the person on the diagnostic end of the call knows the patient, knows her medical history and her body, has treated her before and knows how she describes symptoms, then I believe an accurate diagnosis can be made on the phone as often as it can be made during an in-office exam using the tools presently available," says Bartsich, an associate clinical professor of obstetrics/gynecology at New York Weill Cornell Medical Center.

Women should be given more credit for knowing their own body, Bartsich says, and for being able to accurately describe symptoms over the phone when they are speaking to someone they know and trust.

The study began with 485 women who called Kaiser Permanente with vaginal complaints. Each of the calls was screened by a registered nurse, who asked a battery of questions about symptoms and medical history, and then recorded a diagnosis without revealing that information to the patients.

The women were then given the chance to see a doctor, nurse-midwife or physician's assistant that same day. Following the office exam, another diagnosis was made and treatment was prescribed.

In addition, the women were also given laboratory tests -- cultures and microscopic exams that took anywhere from a few days to a week for definitive results.

Researchers then compared all three findings. They also controlled for the knowledge level of every professional involved in the diagnosis, assuring that differences in expertise would not color the findings.

The result: For the 253 women who completed the study, researchers describe agreement between phone diagnoses and office findings as "extremely poor -- there was a high level of disagreement," says Allen-Davis. This included misdiagnosis of yeast infections, bacterial vaginosis and Trichomonas infections.

Perhaps more importantly, there was also "poor agreement" between office diagnoses and laboratory findings - indicating that conclusions drawn after examination were not always as accurate as tests and cultures. The accuracy gap between telephone diagnoses and laboratory findings was even wider.

But what really threw researchers for a curve was the two-week follow-up statistics: Eighty percent of the women got better based on the office-based treatments, even though laboratory tests showed the treatments might have been incorrect.

The study authors blame those findings on inadequate follow-up.

"It wasn't long enough," Allen-Davis says. Had the women been checked at four weeks, and again at six weeks, she believes those who received inadequate treatment would probably have reported another round of symptoms.

"Many vulvovaginal complaints ebb and flow naturally, getting a little better on their own and then flaring again if proper treatment isn't rendered," Allen-Davis explains.

Bartsich agrees, but he adds more reliable ways to diagnose vaginal problems in the doctor's office are needed.

"We need better, faster and more accurate means of diagnosing these problems to insure these complaints are not overlooked, under-diagnosed or under-treated," says Bartsich.

The study appears in the January issue of The Journal of The American College of Obstetrics and Gynecology.

What To Do: For more information on vaginal health concerns, visit the National Institutes of Health. You can also visit the National Vaginitis Association.

SOURCES: Interviews with Jandel T. Allen-Davis, M.D., department of obstetrics and gynecology, Kaiser Permanente, Wheat Ridge, Colo.; Ernst Bartsich, M.D., associate clinical professor, obstetrics and gynecology, New York Weill Cornell Medical Center, New York City; January 2002 The Journal of The American College of Obstetrics and Gynecology
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