The effect of introduction of a guideline on the management of vaginal discharge and in particular bacterial vaginosis in primary care
Journal - Family Practice
Background. Bacterial vaginosis (BV) is the commonest causeof vaginal discharge, and its association with obstetric andgynaecological complications is being recognized increasingly.It was our impression that BV was poorly understood and underdiagnosedin family practice.Objective. The aim of this study was to explore the managementof patients with vaginal symptoms by family practitioners andto see if the management changed after the assimilation of bestpractice guidelines.Method. Family practitioners were invited to complete a baselinequestionnaire of their perceived practice, and to record actualpractice when consulted about vaginal symptoms, for a minimumof 4 weeks. Consensus best practice guidelines were then providedand practice recorded for a similar period.Results. Baseline data was received from 34 practitioners andsuggested that the symptoms and signs of different vaginal infectionswere not well known. Most symptomatic patients were only investigatedat re-presentation with unresolved symptoms or at recurrence,and 43% of respondents treated with empirical antifungals asa first line approach. Pregnant patients were only occasionallyasked about symptoms and only occasionally examined if symptomatic.Pre-guideline practice data from 30 practitioners showed 1.2patient consultations/week, of which 60% were examined and 55%had a high vaginal swab (HVS) sent. Only 2% had near-patienttests done. Post-guideline data from 23 family practitionersshowed a lower recorded consultation rate at 0.7/week, but 90%of these were examined, 77% had an HVS sent and 69% had near-patienttests done. Of the 36 HVS examined by Gram stain, 19 (53%) showedLactobacillus predominant flora and 10 (28%) suggested BV. Seven(19%) were borderline or ungradable. Only three (8%) showedyeasts, one of which also showed BV.Conclusions. Baseline data supported our impression that BVwas under-recognized. Guidelines appeared to improve the rateof investigation of women consulting with vaginal symptoms.
|Keywords : ||Bacterial vaginosis • family practice • guideline • management|