Management strategies for urinary and vaginal infections

Abstract

Detailed history, physical examination, laboratory and follow-up data were obtained from 821 women coming to a primary care clinic over a 2-year period with the symptoms of urinary tract (UTI) or vaginal infection. Using all available information, each patient retrospectively was given 1 of several mutually exclusive diagnoses. Vaginitis without UTI was diagnosed in 70% of patients, UTI without vaginitis in 12%, UTI and vaginitis in 2%. The conditional probability of the several possible diagnoses was calculated, given various combinations of clinical data; a diagnosis of vaginitis was twice as likely as a diagnosis of UTI in a patient with dysuria. On the basis of these calculations, efficient clinical strategies for when to perform a pelvic examination, a urinalysis and a urine culture, and when to diagnose UTI presumptively on the basis of urinalysis were identified.