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GPs prefer more direction from laboratory reports on vaginal discharge

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Narrowing the gap between the information doctors want from high vaginal swab (HVS) samples and what laboratories currently provide could improve the management of vaginal discharge in general practice, according to a survey in England.

Around three quarters of the 500 plus general practitioners (GPs) responding wanted laboratory reports to suggest a diagnosis based on microbiological results—which six PHLS laboratories in their area do—and to suggest treatment—which only two do and some consider is not their remit. Three quarters of the GPs said they would take an HVS sample for vaginal discharge in a young woman, and three quarters would request microscopy, culture, and antibiotic sensitivity testing.

Responses from the laboratories indicated wide variation in processing and reporting on such samples; a national guideline on processing could at least address some disparities, as there is no existing PHLS standard.

The survey asked 2146 GPs in North Thames region how they would investigate and manage a theoretical case—a 20 year old woman taking the combined oral contraceptive pill with two weeks’ vaginal discharge after changing her male sexual partner. The 22 laboratories in the region were asked specific questions about how they processed and reported HVS samples.

In 2002 the government advocated greater GP input in managing sexually transmitted diseases, and processing HVS samples is a large component of PHLS work. GPs’ expectations of the test and whether they are fulfilled are largely unknown, but it seems that more specific advice might be a cost effective improvement.