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Bacterial vaginosis

High Empiric Treatment Rates for Vaginitis Compromise Accuracy of Diagnosis and Treatment in the US

Strategic Insights

— 1 min read

Researchers have found that there is a significant issue with the empiric treatment of vaginitis in the United States. The study, published in the journal Sexually Transmitted Diseases, revealed that a substantial proportion of patients with vaginitis symptoms receive empiric treatment, which is not aligned with positive test results. This approach can lead to inappropriate treatment and compromise the accuracy of diagnosis.

Key Takeaways:

  • The study identified 1465 pregnant and 13,447 nonpregnant patients with vaginitis symptoms in the United States between 2018 and 2023.
  • The prevalence of bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomoniasis (TV) was 31.7%, 26.3%, and 2.0% among pregnant patients, and 26.6%, 16.1%, and 2.0% among nonpregnant patients, respectively.
  • Empiric treatment was common across treated pregnant subgroups, with rates ranging from 55.0% to 66.7% depending on the test method used.
  • In nonpregnant cohorts, empiric treatment rates ranged from 55.7% to 74.2% depending on the test method used.
  • Many empiric treatments were not aligned with positive test results, with coinfections seen in 6.5%-8.2% of pregnant and 11.7%-13.0% of nonpregnant patients who tested BV positive.
  • The study concluded that high empiric treatment rates and evidence of inappropriate treatment highlight the potential utility of rapid, accurate tests to diagnose common vaginal infections.

Statistics:

  • 1465 pregnant and 13,447 nonpregnant patients with vaginitis symptoms were identified in the US between 2018 and 2023.
  • The prevalence of bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomoniasis (TV) among pregnant patients was 31.7%, 26.3%, and 2.0%, respectively.
  • The prevalence of BV, VVC, and TV among nonpregnant patients was 26.6%, 16.1%, and 2.0%, respectively.
  • Empiric treatment rates among pregnant patients ranged from 55.0% to 66.7%, and among nonpregnant patients, ranged from 55.7% to 74.2%.
  • Coinfections were seen in 6.5%-8.2% of pregnant and 11.7%-13.0% of nonpregnant patients who tested BV positive.

Sources:

  • Prevalence and Accuracy of Empiric Treatment Among Patients With Vaginitis Symptoms in the United States. Sexually Transmitted Diseases, 2025;52(11):690-698.
  • Lippincott Williams & Wilkins, Two Commerce Sq, 2001 Market St, Philadelphia, PA 19103, USA.
  • Justin Chen, IQVIA, Durham, NC.
  • Jenny Tse, Liucheng Shi, Mindy M. Cheng, Rebecca Lillis, and Aimee M. Near.

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