‘Think more broadly’ with STI co-testing for all women with vaginitis

Key takeaways:

• About one in nine people who present with vaginitis symptoms also have at least one STI.
• CDC recommends co-testing for STIs when women are diagnosed with vaginitis, particularly bacterial vaginosis.

Vaginitis, including yeast infections and bacterial vaginosis, affects up to 75% of women at least once in their lives, yet many women are unaware that a sexually transmitted infection, or STI, could be the cause.

Despite advancements in testing, many clinicians continue to rely on traditional methods, missing potential opportunities to improve detection and treatment outcomes, according to Kameelah Phillips, MD, FACOGM NCMP, founder of Calla Women’s Health based in New York City. Data suggest more than 40% of women with vaginitis symptoms in a community practice setting received inappropriate treatment and were infrequently evaluated according to the CDC-recommended point-of-care tests. Additionally, STI coinfections are often not considered when patients present symptoms for vaginitis, Phillips said. By using comprehensive STI co-testing for all women with vaginitis, clinicians can differentiate infections with overlapping symptoms and ensure appropriate treatment, Phillips said.

Healio spoke with Phillips about vaginitis misconceptions, how missed infections impact women’s reproductive health and how co-testing improves STI detection and treatment.

Healio: What causes vaginitis, and how is it typically diagnosed?

Phillips: Vaginitis is what it sounds like: Inflammation of the vagina. It is a really uncomfortable condition. Women typically report itching, discomfort and pain due to an imbalance of the homeostasis of the vaginal flora. It is often caused by yeast, yes, but also can be caused by bacteria. I see several cases every day, and it is one of the more common reasons people come to the OB/GYN. Vaginitis accounts for approximately 21 million visits to the OB/GYN each year. When it happens to you, you know.

Healio: What are some of the misconceptions about vaginitis?

Phillips: Not everyone is so clear about their anatomy, so conceptualizing vaginitis can be challenging. The urethra is above the vagina, so it is often thought to be a urinary tract infection. Some people attribute the symptoms to their regular vaginal discharge or think it is a yeast infection. People may incorrectly self-diagnose and purchase over-the-counter creams, which of course do not work. That is why it is so important to visit your doctor. It could also be an STI.

Healio: What does the research tell us about how many women with vaginitis also have coinfection with an STI?

Phillips: We know that about one in nine people who present with vaginitis symptoms also have at least one STI. That is why awareness, testing and subsequent follow-up and treatment is so important. When women test positive for bacterial vaginosis (BV) — which causes about half of our vaginitis cases — they are twice as likely to have an STI compared with people who do not have BV. BV and STIs tend to occur together. That is why clinicians must test for both together and do not assume it is one or the other, especially for people who are sexually active. The CDC recommends that if you have BV, you should also be tested for STIs. This makes sense, even when it comes to protecting your reproductive health. There can be complications from undiagnosed STIs, so we must think more broadly.

Healio: What is the best method to test for STI coinfection?

Phillips: From a patient perspective, it is nucleic acid amplification testing, or an NAAT. It is helpful. Compared with other testing — urine or other testing methods — it has higher sensitivity and specificity for more accurate and timely diagnosis. It is convenient for doctors and patients. It is a one-time swab to test for multiple infections, identify and treat. It streamlines the process for providers and patients. Here in my office, it is an important part of our workflow. It prevents people from coming back unnecessarily and prevents unnecessary treatment. I am not guessing about what you may have; I know what you have. In our office, we normalize with patients that when you have vaginitis, yes, you will also receive STI testing.

Healio: Why is it important to conduct STI co-testing for women with vaginitis?

Phillips: This is not a small issue, especially when you think about how many women are impacted. That is why it is so important to talk about this. The delay of an untreated infection or a misdiagnosis has a significant impact on a women’s reproductive health. We are talking about pelvic inflammatory disease, ectopic pregnancy, tubal infertility. These are devastating consequences for women. We must test everyone together so we do not miss that one in five who does have an STI. That one in five has long-term implications for women and their health. This does not just apply to women who say they are sexually active. This includes pregnant women, older women — everyone. STIs do not discriminate.

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Kameelah Phillips, MD, FACOG, NCMP, can be reached on Instagram at @drkameelahsays.