Variability of vaginal pH determination by patients and clinicians.

PURPOSE: Measurement of intravaginal pH provides a reasonable assessment of vaginal health but is fraught with the potential for several sampling errors. The purposes of the study were to determine the variability of self-sampled vaginal pH among women using an inexpensive swab-based pH test compared with a clinician-obtained specimen, and variability of vaginal pH within 3 regions of the normal vagina. METHODS: In this cross-sectional study, women obtained a vaginal specimen using a cotton-tip applicator, transferred it to pH paper, and interpreted the results. A clinician also blindly interpreted these tests. Thereafter, a clinician obtained 3 swab specimens from the proximal, middle, and distal vagina for pH testing. Results were compared using Wilcoxon signed rank test, interclass correlation coefficients, Bland-Altman plots, and mixed-model analysis of variance. RESULTS: Interclass correlation coefficients were moderately high comparing subjects with clinician for the swab-based pH test (0.74). Subjects' swab pH values (4.5) were significantly lower than clinicians' pH values (4.7, P = .0001). Intravaginal pH did not vary between the 3 anatomic locations. CONCLUSIONS: Self-sampled intravaginal pH interpretations vary slightly compared with clinician-obtained specimens. Because swab pH sampling does not detect an intravaginal pH gradient in normal women, self-sampling technique may vary considerably without affecting outcomes. Our findings support self-sampling for vaginal pH before using over-the-counter products for presumed vaginitis.

Colposcopy quality control for clinical trials: the positive effects from brief, intensive educational intervention.

OBJECTIVE: To determine whether a brief, intensive colposcopy course improves the cognitive skills of colposcopists participating in clinical trials. MATERIALS AND METHODS: Twenty-two colposcopists involved in a multicenter clinical trial attended an intensive colposcopy course designed to improve diagnostic skills. Participants completed a pretest and posttest of 10 case-based studies and the ASCCP Colposcopy Recognition Award (CRA) examination. Pre- and posttest exam and CRA results were compared for each individual and the group. RESULTS: The group mean pre- and posttest total scores were 67% and 73%, respectively. There was a significant improvement in posttest colposcopic impression mean scores compared with the pretest (56% and 44%, respectively). The greatest improvement in colposcopic impression mean scores was for low-grade, high-grade, and cancer cases; 25%, 23%, and 20%, respectively. CRA scores did correlate positively with pretest scores. CONCLUSION: A brief, intensive colposcopic educational program improved the cognitive skills of the colposcopists.

Human papillomavirus vaccine acceptability among parents of 10- to 15-year-old adolescents.

OBJECTIVE: To determine human papillomavirus (HPV) vaccine acceptance among parents of 10- to 15-year-old adolescents. MATERIALS AND METHODS: Five hundred seventy-five parents or guardians completed a 30-question survey regarding their knowledge of HPV and acceptance of an HPV vaccine. Afterward, subjects read an HPV educational fact sheet and completed a 26-question survey. Results were compared using the chi test, analysis of variance, and McNemar's test. RESULTS: More than 60% of subjects had a general understanding of HPV. Parents opposed to the HPV vaccine were more likely to believe it would promote earlier initiation of coitus compared with parents supportive or undecided about vaccination (24%, 9%, and 6%, respectively; p = .003). Of the subjects initially opposed to or undecided about the HPV vaccine, 37% and 65%, respectively, supported HPV vaccination after an educational intervention. CONCLUSIONS: A brief educational intervention significantly improved parent's acceptance of the HPV vaccine. The negative impact of an HPV vaccine perceived as condoning early initiation of sexual intercourse seems to be minimal.

Patient acceptance of fluorescent and reflective spectroscopy as a replacement test for the pap smear.

OBJECTIVE: To determine women's acceptance of fluorescent and reflective spectroscopy (FRS) as a potential replacement test for the Pap smear. MATERIALS AND METHODS: Women scheduled for a colposcopic examination, or a colposcopic and FRS examination, completed a 22-item questionnaire that included demographic data, medical history, and preference-type questions. Data were compared using chi and Wilcoxon's rank sum tests. RESULTS: Women considered accuracy, comfort, and quick results to be the most important characteristics for new cervical cancer tests. Immediate test results were preferred strongly by both groups (control, 84.5%; scanned, 88.6%). Provided FRS was more accurate than the Pap smear, most women (control, 74.7%; scanned, 68.2%) would rather have FRS if it cost the same as a Pap smear. CONCLUSIONS: Women consider accuracy, comfort, and time critical issues with respect to FRS used as a primary screening test. Acceptance of this new technology will be facilitated by designing equipment accordingly to satisfy the concerns of women.

Women's responses to cervical interrogation by fluorescent and reflective spectroscopy.

OBJECTIVE: To determine women's responses to cervical interrogation by fluorescent and reflective spectroscopy (FRS). MATERIALS AND METHODS: A convenience sample of women scheduled for a colposcopic examination was interrogated by a cervical FRS system. Thereafter, women completed a 24-item questionnaire that assessed their responses to the spectroscopic test. Likert-scale responses were compared among subgroups using the chi test for trend. RESULTS: Most women favored FRS used for locating (97.7%; 170/174) and selectively sampling (96.6%; 168/174) cervical neoplasia. Fewer women (81.0%; 141/174) wanted FRS to replace the Pap smear. Most women were neither nervous (73.6%; 128/174) nor bothered (89.1%; 155/174) by the extra time for the FRS assessment. Women's acceptance was substantiated by 84.9% (146/174) and 90.8% (157/173) wanting their doctor to have and insurance company to pay for FRS, respectively. CONCLUSIONS: Use of FRS as a colposcopic adjunct was supported very favorably by women. Fewer women supported FRS replacing Pap smears. These high rates of approval by women should help the implementation of FRS technology.

Telemedicine network telecolposcopy compared with computer-based telecolposcopy.

OBJECTIVES: To compare computer-based telecolposcopy with telemedicine network telecolposcopy. MATERIALS AND METHODS: An on-site expert and local clinician at two rural sites conducted colposcopic examinations on 264 women. Colposcopic images were captured and transmitted to two other experts at a remote location using a statewide telemedicine system and a computer and modem-based system. Sensitivity and specificity, agreement of examination adequacy and management, effects of delayed interpretations, and costs were compared for each system. RESULTS: A greater rate of satisfactory colposcopy results was reported by the telemedicine network (66.1%) compared with computer-based (43.6%) telecolposcopy (p < .0001). Greater rates of cervical biopsy (p = .005) and endocervical curettage (p = .03) were required by delayed telecolposcopy compared with immediate telecolposcopic services. There were no significant differences in sensitivity of detecting cervical neoplasia among the types of the telecolposcopy. Computer-based telecolposcopy cost 28 dollars less per patient than telemedicine network telecolposcopy. CONCLUSIONS: Computer-based telecolposcopy may be a reasonable, cost-effective adjunct to on-site colposcopy for evaluating women in medically underserved areas. Synchronous telecolposcopic examination minimizes histologic sampling and improves consultation.

Personal digital assistants used to document compliance of bacterial vaginosis treatment.

OBJECTIVE: The objective of this study was to estimate patient compliance with oral and vaginal metronidazole treatment of bacterial vaginosis using personal digital assistants (PDAs) and paper diaries. GOAL: The goal of this study was to assess a novel compliance documentation approach. STUDY: After each dose of intravaginal or oral metronidazole, 71 subjects recorded the time on a paper diary and answered questions on a PDA. All PDA entries were unknowingly time-date-stamped. Subjects returned for 2- and 6-week posttreatment examinations. Compliance was calculated using a repeated-measures multivariate analysis of variance (ANOVA). RESULTS: Mean patient compliance rates within the oral metronidazole group were greater with the paper diary compared with the PDA (68.3% and 50.0%, respectively, P = 0.001). The observed rate of compliance agreement for PDA versus paper diary was 69.0% (kappa = 0.4). The majority of noncompliant subjects reported they were compliant with the PDA and paper diary. CONCLUSIONS: PDAs could more accurately document true compliance rates and could be reasonable instruments to assess compliance in intravaginal antimicrobial drug or contraceptive trials.