Vaginal discharge and acute cystitis in women. A shift of another paradigm? Alidjanov J.F.1, Pilatz A.1, Abdufattaev U.A. 2, Naber K.G.3, Wagenlehner F.M.1 1Justus
Liebig University, Clinic for Urology, Pediatric Urology and Andrology, Giessen, Germany; 2JSC “Republican Specialized Center of Urology”, Dept. of Radiology, Tashkent, Uzbekistan; 3 Technical University of Munich, Dept. of Urology, Munich, Germany. Table 1. Demographic data of the study population
Abstract
Country
Introduction & Objectives The paradigm of the recent years: “the presence of vaginal discharge (VD) decreases the probability of acute uncomplicated cystitis (AC) in women”. Research question: what are the diagnostic values of complaints about abnormal VD for AC in women? Study tool: The Acute Cystitis Symptom Score - a self-reporting questionnaire for the diagnosis and the differential diagnosis of the AC in women [1]. The aim of the study: Reassessment of the probability of AC in women, with and without complaints about VD, using a large database from previous ACSS validation studies. Design of the study: Case-control study.
Germany Hungary Russian Federation Tajikistan Great Britain Uzbekistan Total
Results
Number of respondents [Controls(%)/Patients (%)] 81 [57(70.4%)/24(29.6%)] 68 [37(54.4%)/31(45.6%)] 199 [(91(45.7%)/108(54.3%)] 44 [13(29.5%)/31(70.5%)] 18 [12(66.7%)/6(33.3%)] 422 [194(46.0%)/228(54.0%)] 834 [406(48.7%)/428(51.3%)]
Mean age ±SD (range) Mean age ±SD (range) for Mean age ±SD (range) Controls for Patients for population 33.0±16.5 (16-90) 28.7±11.1 (19-69) 43.3±22.1 (16-90) 45.3±17.7 (16-85) 48.0±14.1 (19-85) 42.0±21.0 (16-78) 42.3±15.5 (17-79) 41.8±13.2 (19-67) 42.8±17.3 (17-79) 42.7±15.9 (19-77) 34.5±10.8 (20-61) 46.1±16.7 (19-77) 50.7±19.6 (16-72) 50.0±19.8 (16-70) 52.2±21.1 (23-72) 33.0±12.5 (15-87) 33.5±12.5 (15-75) 32.5±12.6 (16-87) 37.1±15.4 (15-90) 35.5±14.1 (15-85) 37.7±16.5 (16-90)
Table 2. Diagnostic values of abnormal vaginal discharge for acute uncomplicated cystitis
Fig. 1. The flowchart of the case-selection process
Materials & Methods The process of the data selection for the analysis is illustrated in Fig. 1. Analysis of diagnostic values of VD and its severity was performed, using recommended statistical tests, using 2x2 contingency tables (sensitivity, specificity, likelihood ratios, relative risk, etc.). The strength of associations was assessed by Spearman’s rho. P-value and 95% CI were used for the assessment of the statistical significance. R with preinstalled packages was used for the statistical analysis of the data [2, 3].
Dr. Jakhongir F. Alidjanov, MD Urologist, researcher, PhD Doctorate Justus-Liebig-University, Dept. of Urology, Pediatric Urology and Andrology Address: Rudolph-Buccheim Str.7, 35392 Giessen, Germany E-mail:
[email protected]
Symptom's severity None Mild Moderate Severe
Sensitivity (95%CI) 0.74 (0.70-0.79) 0.14 (0.11-0.17) 0.08 (0.06-0.11) 0.04 (0.02-0.06)
Specificity (95%CI) 0.17 (0.13-0.21) 0.89 (0.85-0.92) 0.96 (0.93-0.97) 0.98 (0.97-0.99)
LR+/LR- (95%CI)
PPV/NPV (95%CI)
0.90 (0.83-0.96)/1.51 (1.15-1.98) 1.23 (0.85-1.78)/0.97 (0.92-1.02) 1.93 (1.10-3.38)/0.96 (0.93-0.99) 2.34 (0.92-5.97)/0.98 (0.96-1.00)
0.49 (0.45-0.53)/0.38 (0.31-0.46) 0.57 (0.47-0.67)/0.49 (0.45-0.53) 0.67 (0.53-0.80)/0.49 (0.46-0.53) 0.71 (0.48-0.89)/0.49 (0.45-0.52)
Notes: CI - confidence interval, LR - likelihood ratio, PPV - positive predictive value, NPV - Negative predictive value
Correlation with diagnosis -0.10 (-017--0.04) 0.04 (-0.03-0.11) 0.08 (0.01-0.15) 0.06 (0.00-0.13)
Fig. 2. Odds ratio for different severity of abnormal vaginal discharge
Demographic data of selected respondents is given in Table 1. Distribution of the study population into groups and subgroups is illustrated in Fig.1. Pretest probability (prevalence) of VD among the whole population was 0.51 (0.48 to 0.55). Results of the diagnostic values of VD for AC are given in Table 2 and Figures 2-4.
Fig. 5. Values of the risk difference between presence and absence of „typical“ symptoms
Conclusions According to the results of our study, the presence of VD, indicating the probability of genital infections, does not decrease, but rather slightly increases the probability of AC in women. Therefore, we consider that the paradigm regarding the role of VD to decrease the probability of AC is at least debatable. Thus, we recommend more thorough investigations in women complaining of signs of VD in addition to the typical symptoms of AC. Further, well-designed studies including pelvic examination are needed to clarify the association between VD and AC.
References
Fig. 3. Risk ratio for different severity of abnormal vaginal discharge
Fig. 4. Risk difference for different severity of abnormal vaginal discharge
Fig. 6. Values of the risk difference between presence and absence of investigated symptoms
[1] Alidjanov JF, Abdufattaev UA, Makhsudov SA, Pilatz A, Akilov FA, Naber KG, et al. New self-reporting questionnaire to assess urinary tract infections and differential diagnosis: acute cystitis symptom score. Urol Int 2014;92:230–6. doi:10.1159/000356177; [2] R Core Team. R: A Language and Environment for Statistical Computing 2017; [3] Schwarzer G. meta: An R package for meta-analysis. R News 2007;7:40–5. Note: More detailed information about the Acute Cystitis Symptom Score (ACSS) may be found via the website: http://www.acss.world
