Women with persistent/recurrent vaginal discharge should be offered multiplex-7 PCR testing

Abstract

Background: Recurrent vaginal discharge is an important cause of repeated visits to the gynaecologists. Failure to correctly identify the causative organism with standard microscopy and culture techniques results in repeated unsuccessful treatment and the risk of developing antibiotic resistance. Multiplex PCR test is increasingly being used for investigating infections where multiple organisms may be involved. Methods: This was a retrospective review of women attending the Feto Maternal Centre, Doha Qatar with the complaint of persistent/recurrent vaginal discharge over a period of 8 years who were tested by both the standard approach and a multiplex 7-PCR. Results: A total of 536 women with vulvovaginal discharge (474 with persistent/recurrent discharge and 62 with first episode) had been investigated with 7-PCR and treated. 7-PCR was able to identify a possible infective organism in 85% of those with persistent/recurrent discharge and 95% of those presenting with symptoms for the first time. The most common microorganisms were the sexually transmitted infections Ureplasma urealyticum, Mycoplasma genitalium and Gardnerella vaginalis. At follow-up 88.2% of symptoms had been eradicated. Conclusion: Multiplex 7-PCR is more likely to identify an infective cause of vulvovaginal discharge than standard microbiology tests. The most common organisms identified were Ureplasma urealyticum, Mycoplasma genitalium and Gardnerella vaginalis. While the standard tests can identify other pathogens that may be associated with vulvovaginal discharge 7-PCR offers an advantage in that it is able from a single swab to screen for 7 organisms. Since it does not screen for Candida albicans, we feel that whenever this is offered, standard screening for candida should be offered unless the PCR test kit included screening for candida. We suggest that multiplex-PCR should be considered as the standard screening test for women presenting with first episode or recurrent vulvovaginal discharge.