Self-reported yeast symptoms compared with clinical wet mount analysis and vaginal yeast culture in a specialty clinic setting.

OBJECTIVE: To determine the validity of patients' self-reported symptoms of vulvovaginal candidiasis and the accuracy of clinical wet mount examinations compared with vulvovaginal yeast culture results in a specialty clinic. STUDY DESIGN: A retrospective chart review of new patients seen at the Saint Louis University Vulvar and Vaginal Disease Clinic from January 2005 to March 2006 was performed. Patients' age, medication use, symptom scores on a rating scale for vaginal/vulvar pain, burning, itching, dyspareunia and wet mount analyses were compared with yeast culture results. RESULTS: Of 153 patients, 40 had positive yeast cultures (prevalence rate 26.1%). Compared with yeast cultures, self-reported symptom scores >4 resulted in high sensitivity (90%) and low specificity (7%). Positive wet mount result showed low sensitivity (18%) and high specificity (99%). Patient symptom scores were a poor predictor of yeast infections based on yeast culture results. No correlation was found among wet mount, self-reported symptoms and yeast culture results. No significant difference between age or symptom scores to culture result was found. CONCLUSION: Wet mount analysis for recurrent or persistent patient symptoms should be reevaluated. Self-reported symptoms are not reliable for diagnosis. Wet mount analysis resulted in low sensitivity. Yeast cultures should be considered the gold standard for identification of vulvovaginal candidiasis in persistent or recurrent cases.

Medical student identification of domestic violence as measured on an objective, standardized clinical examination.

OBJECTIVE: This study examined the incidence and predictors of domestic violence screening by third-year medical students at an end of clerkship Objective Standardized Clinical Examination. STUDY DESIGN: Two hundred and seventy-five third-year medical students completed an 8-station end of clerkship Objective Standardized Clinical Examination as part of this retrospective observational study, one with nonspecific abdominal pain and possible domestic violence. Checklists on history, physical, communication, and interpersonal skills were collected. Domestic violence screening was analyzed by logistic regression and analysis of variance. RESULTS: The incidence of domestic violence screening by history alone was 34% before the physical. Interpersonal scores on the overall exam and domestic violence station, but not gender or rotation sequence, predicted domestic violence questioning. CONCLUSION: In this standardized patient study there was a low rate of domestic violence screening by history.