Improving Appropriate Use of Antifungal Medications: The Roleof an Over‐the‐Counter Vaginal pH Self‐Test Device

Abstract

Objectives:To determine whether patients can understand and use the vaginal pH device in the diagnosis of vaginitis. To compare whether vaginal pH readings determined by patients and healthcare providers are similar. To determine whether vaginal pH can reduce inappropriate over-the-counter (OTC) antifungal medication use and improve the correct diagnosis of vaginitis. Methods: One hundred and fifty-one women indicated their belief about the cause of their vaginal infection, read the instructions of the vaginal pH device package insert, used the device and interpreted the findings. The patient interpretations were compared with results obtained by healthcare providers, blinded to patient findings. Results: Over 96% of patients stated that they could easily read the instructions, use the vaginal pH device and interpret the readings. They obtained the same readings as healthcare professionals (Kappa = 0.9). Restricting the use of OTC antifungal medications to those individuals with vaginitis symptoms and vaginal pH ≤ 4.5 significantly reduced inappropriate use by approximately 50%, Fisher's exact test, p-value = 0.018. Conversely, seeking healthcare provider assessment with vaginal pH > 4.5, leads to correct diagnosis of vaginitis. Conclusions: The vaginal pH device can be used as an OTC diagnostic tool by consumers when a vaginal infection is suspected. Vaginal pH readings would direct patients whether to purchase an antifungal medication or seek professional diagnosis from a healthcare provider. Understanding and use of this vaginal pH device could reduce inappropriate use of OTC antifungal medications by approximately 50% and improve the correct diagnosis of vaginitis.

Adolescent women can perform a point-of-care test for trichomoniasis as accurately as clinicians

“…The first used a questionnaire to assess whether adult women could understand the package insert, and 97.1% gave correct answers to at least 75% of the questions. In another study, pH results obtained by adult women were highly correlated with healthcare professional's results (κ=0.9) 27 28. Vaginal pH may be useful in distinguishing candidiasis from BV; however, while we and others have shown that abnormal pH is associated with trichomoniasis, pH is neither sensitive nor specific enough to use as a diagnostic tool for trichomoniasis or other STI.…”

The Accuracy of Women Performing Vaginal pH Self-Testing

“…[16][17][18] It is interesting that the majority of our subjects had a vaginal pH Ͼ4.5. Apparent elevation of vaginal pH may occur because of the presence of menstrual blood, semen, or lubricating gels or improper handling of the pH paper.…”

advances in diagnosing vaginitis: Development of a new algorithm

“…As noted earlier, Ferris and colleagues [6•] found that BV was the most common missed and unrecognized condition in women about to self-treat for VVC. With the availability of self-testing for vaginal pH, it has been estimated that 50% of inappropriate antifungal use could be avoided [15]. Although this approach is as yet unstudied, if a symptomatic patient were to call her health care provider and describe both her symptoms and her vaginal pH, one could assume that the provider would be more likely to decide whether she needed to be evaluated or could proceed with self-treatment.…”