Are a speculum examination and wet mount always necessary for patients with vaginal symptoms? A pilot randomized controlled trial

Purpose: The suggested evaluation of vaginal symptoms is based on the wet mount diagnosis of candidiasis, trichomoniasis, and bacterial vaginosis. We wondered if patients with vaginal symptoms could be managed initially based solely on symptoms. Methods: This pilot randomized controlled trial was conducted in 2 urban family practice clinics and enrolled 46 premenopausal, nonpregnant women with acute vaginal symptoms. In the control arm, women were managed based on a speculum examination and wet mount. In the intervention arm, women were managed based on symptoms. Women were tested for gonorrhea, chlamydia, and trichomoniasis and called 2 weeks later to assess symptom resolution, adverse medication effects, need for revisit, and satisfaction with care. Results: Forty-one of 44 women (93%) felt better 2 weeks after the visit; 28 (64%) had complete resolution of symptoms. The intervention arm had slightly better resolution of symptoms (P = .046); there were other no differences between the 2 arms. Three women were diagnosed with sexually transmitted diseases (trichomoniasis, chlamydia, and gonorrhea). Conclusions: Our pilot study suggests that in selected women it may be reasonable to initially manage vaginal complaints based on symptoms. These results should be confirmed in other larger trials. Testing for sexually transmitted diseases is important in our population.