Validade do diagnóstico clínico de candidíase vulvovaginal / Validity of clinical diagnosis of vulvovaginal candidiasis

RESUMO

Com o objetivo de verificar a validade do diagnostico clínico para a candidíase vulvovaginal e utilizando como padrão-ouro a cultura de secreção vaginal, realizou-se uma análise em 93 pacientes atendidas pelo serviço de Ginecologia da Faculdade de Medicina de Barbacena. As pacientes procuraram o serviço por demanda espontânea, para consulta ginecológica de rotina. Foram submetidas a anamnese e exame ginecológico, com o intuito de avaliar os dados epidemiológicos, sintomas e sinais clínicos. Foi colhido material para a cultura da secreção vaginal, semeada em ágar Sabouraud. A prevalência da Candida foi de 47,91%. A acurácia do exame clínico foi de 0,78, tendo sensibilidade (S) de 82,6% e especificidade (E) de 74,46%. Os achados que tiveram relevância foram a presença de fluxo grumoso (S: 82,60% e E: 78,72%), a citologia positiva para Candida (S: 60,86% e E: 95,74%) e a presença de processo inflamatório (S: 60,86% e E: 87,23%). Os valores de OR foram estatisticamente significantes e todos obtiveram um p<0,001.

ABSTRACT

To verify the validity of clinical diagnosis of vulvovaginal candidiasis by itself and associated with fresh examination using the culture of vaginal secretion as gold standard. An analysis was carried out on 93 patients that were seen by the department of Gynecology from Faculdade de Medicina de Barbacena, which looked forward the service by spontaneous demand for routine gynecological appointment. They were subjected to a anamnesis for the evaluation of clinical symptoms and epidemiological data, the gynecological exam was performed and each data was discriminated. To make the clinical diagnosis, widely disseminated criteria by literature were used, such as vulvovaginal intense itching and burning, swelling and vulvar erythema, dyspareunia, vaginal secretions, white, flocculated, thick and inodorous. The last step was to collect material to vaginal secretion culture and sent it to a laboratory of microbiology to grow on Sabouraud agar, until 48 hours after the collection. In the study the prevalence of vulvovaginal candidiasis in patients, based on the culture, was 47.91%. The accuracy of clinical examination was a 0.78, and sensitivity (S) of 82.6% and specificity (E) of 74.46%. The findings that have great relevance were the presence of flocculated flow (S: 82.60% and E: 78.72%), positive cytology for Candida (S: 60.86% and E: 95.74%) and the presence of inflammatory process (S: 60.86% and E: 87.23%). The odds ratio of these items were also statistically significant and all get a p<0,001.