PLEASE NOTE: This card should only be used to suggest possible diagnoses for follow-up testing. Individuals are discouraged from initiating any home treatment until a particular diagnosis is confirmed by a vaginal wet mount examination or other diagnostic testing in a doctor's office.
IMPORTANT: Women who plan to purchase one of the diagnostic packs from this website are asked to either print off these instructions and explanations for proper card use which follow, or to refer back to them on-line, as this important information is not included with the diagnostic packs.
Please read the following instructions for the proper use of this card:
Interpeting pH Readings
PH is a measure of how acidic a fluid is. The pH of healthy vaginal secretions exists within a narrow range around 4.0. There is no perfect cut-off value that demarcates a healthy vaginal status on one side and a diseased status on the other. This diagnostic card follows the lead of many research studies in defining vaginal secretions with a pH value of 4.7 and above as decidedly abnormal and also highly suggestive of bacterial vaginosis. This unfortunately allows that a woman with a "normal" vaginal pH reading of 4.4 might also have an early or mild case of bacterial vaginosis; however, in this situation, this pH value would be expected to eventially rise into the clearly abnormal range over time. The pH value of 4.7 on the diagnostic card is readily distinguishable as the point where the orange coloration of the lower pH readings has given way to a dark olive coloration. It is important to note here that most computer printers will produce some color distortions of these color strips when copies of this diagnostic card are printed from this website. Vaginal secretions with an actual 3.8 or lower range will read 4.0 on these diagnostic test strips. Otherwise, the diagnostic test strips being offered through this website have an accuracy to within 0.1 pH.
Interpreting the Leukocyte Esterase Test
Two of the diagnostic strips in the Vaginal 2+2 pack and the Vaginal 30+2 pack have a second test slip added to the tip of these strips to test for the presence of leukocytes, also known as white blood cells. Leukocytes are released by the body's immune system to target and to kill groups of invading bacteria deemed harmful to the body. Leukocyte esterase is a chemical enzyme released by these white blood cells which when present in moderate-to-large levels indicate a significant inflammatory response is being launched to the invading bacteria. Inflammatory responses are characterized by some sort of pain or irritation, redness, swelling, and sometimes fever. The vaginal or cervical infections caused by invasive yeasts, Chlamydia, gonorrhea, and trichomonas all are characterized by some if not most of these symptoms, and the discharges associated with each of these infections will be found to test positive for moderate-to-high levels of leukocytes esterase activity. In contrast to what occurs with these infections, the vaginosis-associated bacterial groups typically produce no inflammatory response within the vagina and hence the vaginal discharge caused by bacterial vaginosis should test negative for leukocyte esterase activity.
Coming to Conclusions regarding Possible Diagnoses
This Bacterial Vaginosis Diagnostic Card highlights three possible diagnoses: highly suggestive for bacterial vaginosis; possible Candida albicans vaginal infection; and other diseases, including sexually-transmitted diseases. Bacterial vaginosis is strongly suggested when vaginal pH measures 4.7 or above and the leukocyte esterase test is either frankly negarive or only registers a small reaction. On the other hand, a "not-so-common" vaginal yeast infection should be considered when the vaginal pH is in the normal pH range ( or around 4.0) and the leukocyte esterase test is positive and especially in the right clinical situation such as a woman experiencing an itchy vaginal discharge following just completing an antibiotic, including metronidazole or clindamycin, penicillin, amoxicillin and the like. A woman should question whether an undiagnosed trichomonas infection might be present when the vaginal pH is 4.7 or above and the leukocyte esterase test registers a moderate-to-large accompanying inflammatory reaction. The question of sexually-transmitted disease is especially germaine when a woman's symptoms include not just a vaginal discharge but vaginal pain, lower abdominl pain, pain with vaginal intercourse, and fever-- none of which should be present when bacterial vaginosis is present alone. In addition, other sexually-transmitted diseases, such as Chlamydial cervical infection, can manifest with an elevated vaginal pH reading in combination with a moderate-to-large leukocyte esterase reaction. The key point to be understood here is that any leukocyte esterase reaction in this elevated range absolutely requires urgent evaluation by a doctor or other health care provider who should perform a thorough pelvic examination including a vaginal wet prep and appropriate culture or PCR tests as appear appropriate. Women patients with significant inflammatory component to a new or recurring vaginal discharge may also have bacterial vaginosis present, but patients should be skeptical if they are told that there is nothing other than bacterial vaginosis present-- particularly if the doctor confirms that there are a significant number of white blood cells seen in the vaginal wet prep. I would not hesitate to recommend that a woman go for a second opinion if her doctor presses her to accept some prescription (especially Clindesse!) without an adequate examination and testing or if the woman senses that her doctor is not truly interested in openly explaining to her any abnormal office testing results.