Paper
Saturday, July 14, 2007
Self-Diagnosis of Vaginal Infections by Active Duty U.S. Military Women
Nancy A. Ryan-Wenger, RN, PhD, CPNP, College of Nursing, The Ohio State University, Columbus, OH, USA and Nancy K. Lowe, RN, CNM, PhD, School of Nursing, Oregon Health & Science University, Portland, OR, USA.
| Learning Objective #1: Describe the need for self-diagnosis tools for women in the military, those who travel or work in other austere environments. |
| Learning Objective #2: List the components of a self-diagnosis algorithm for vaginal symptoms. |
Military women are particularly vulnerable to vulvovaginal pain, itching, burning, and vaginal discharge during deployment. Our goal is to develop a field-expedient self-diagnosis/self-treatment kit for bacterial vaginosis (BV), trichomoniasis vaginalis (TV), or candida vaginalis (CV). This report focuses on the accuracy of women’s self-diagnosis of vaginal symptoms using an investigator developed kit (Women in Military Self-Diagnosis (WMSD)) compared to a DNA Probe analysis of vaginal secretions. The innovativeness of the diagnostic kit is the combination of readily available products with step-by-step instructions and a decision-making algorithm that leads to a self-diagnosis. The criterion is eventual accurate treatment with metronidazole or fluconazole, or no treatment. This study used a clinical comparative and descriptive design. The sample was 715 active duty U.S. military women (44% Army, 52.7% Navy, and 3.5% Other Branches), 546 of whom presented for healthcare with vaginal symptoms. Participants were 38.5% Black, 33.8% White, 18.2% Hispanic or Latino; 41.6% married/cohabiting and 38.1% single; 18 to 54 years (X = 26). The majority was senior (66.4%) or young (25.7%) enlisted personnel. The WMSD had a positive predictive value (PPV) of 63% and negative predictive value (NPV) of 50.1% for BV/TV; a PPV of 37.5% and NPV of 78.1% for CV. Overall, 211 (41.9%) of the women would have self-treated in the same way as indicated by the DNA Probe result for BV/TV, and/or CV; 56 (11.1%) women would have partially self-treated in the correct way due to mixed infections; 152 (30.2%) would have taken the wrong medication (commission error); 84 (16.7%) would not have taken an indicated medication (omission error). Analysis of the potential commission errors provides direction for revision and refinement of the WMSD. This kit has the potential to significantly improve the self-care of military women and women world-wide who travel extensively and/or live in other austere environments.