Vaginitis testing outcomes by documented symptom status in a student-run free clinic: a retrospective study.

Abstract

Background: Vaginitis is a common gynaecologic condition in patients assigned female at birth in the United States, most often caused by bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), or trichomoniasis vaginalis (TV). Symptoms such as discharge, irritation, and burning often overlap. Symptom-based diagnosis is frequently inaccurate, with correct identification in only about half of cases. Empiric treatment without confirmatory testing remains common and can drive inappropriate therapy and antimicrobial resistance. Uninsured populations face higher infection burdens and barriers to care, yet data on vaginitis testing outcomes in student-run free clinics (SRFCs) are limited.

Methods: We conducted an IRB-approved retrospective chart review of patients receiving vaginitis testing at a no-cost SRFC affiliated with a Midwestern academic medical centre between October 2019 and November 2023. 104 testing encounters met inclusion criteria for BV, VVC, or TV testing. Demographics, age, and symptom status were extracted from the electronic medical record. Encounters were categorised as having documented vaginitis symptoms or no documented symptoms at the time of testing. All tests used transcription-mediated amplification. Proportional-difference chi-square tests compared results by symptom status, and logistic regression assessed associations between age and positive test results.

Results: The sample was predominantly comprised of patients assigned female at birth with a mean age of 31.1 years; 38% identified as Black. No significant differences were observed in positive or negative BV, VVC, or TV test results between encounters with and without documented vaginitis symptoms. Comparisons of positive VVC and TV results were limited by the small number of positive cases. Age was not associated with testing positive for BV, VVC, or TV.

Conclusions: Documented symptom status did not consistently correspond with organism-specific test results in this uninsured clinic population. Findings among patients without documented symptoms should be interpreted cautiously because testing was frequently bundled and symptom status was determined retrospectively.