Review of Systems for Vaginal Swab Collection
When obtaining a vaginal swab, the review of systems must focus on genitourinary symptoms, sexual history, and systemic signs that differentiate infectious causes and guide appropriate testing.
Essential Genitourinary Symptoms
Vaginal discharge characteristics including color, consistency, amount (profuse vs. minimal), and whether it adheres to vaginal walls, as homogeneous white discharge suggests bacterial vaginosis while thick white discharge suggests candidiasis 1, 2
Odor of discharge, specifically asking about fishy or malodorous smell, as this indicates bacterial vaginosis or trichomoniasis (pH >4.5) rather than candidiasis 1, 3
Vulvar itching and irritation, which is more prominent in vulvovaginal candidiasis but can occur with any infectious vaginitis 3
Dyspareunia (painful intercourse), as this symptom is significantly associated with infectious vaginal discharge and may indicate cervicitis or pelvic inflammatory disease 4, 3
Dysuria (painful urination), which can accompany trichomoniasis, bacterial vaginosis, or cervicitis from Chlamydia trachomatis or Neisseria gonorrhoeae 3, 4
Critical Pelvic and Abdominal Symptoms
Lower abdominal pain or pelvic pain, as this is a red flag for upper genital tract infection (pelvic inflammatory disease) requiring urgent treatment to prevent serious sequelae including infertility, ectopic pregnancy, and chronic pelvic pain 4, 3
Fever or systemic symptoms, which suggest ascending infection beyond simple vaginitis and necessitate evaluation for pelvic inflammatory disease 4
Sexual and Reproductive History
Sexual activity and partner symptoms, as sexually transmitted infections (trichomoniasis, chlamydia, gonorrhea) require partner notification and treatment, whereas bacterial vaginosis and candidiasis do not 4
Pregnancy status, because bacterial vaginosis in pregnant women, especially those with history of preterm delivery, requires treatment to reduce risk of preterm birth and postpartum endometritis 1
Recent antibiotic use or treatment for vaginitis within the past month, as this increases likelihood of recurrent infection and may indicate treatment failure or resistant organisms 5
Timing and Recurrence Pattern
Duration of symptoms and previous episodes, since recurrent bacterial vaginosis (50-80% recurrence within one year) or recurrent candidiasis necessitates culture to identify non-albicans Candida species requiring different treatment 1, 2
Timing relative to menstrual cycle, as physiological discharge varies with hormonal fluctuations and must be distinguished from pathological causes 4
Procedural History
- Upcoming or recent gynecological procedures, because bacterial vaginosis substantially increases risk for post-procedure infections including post-abortion pelvic inflammatory disease, making pre-procedure diagnosis and treatment critical 1
Common Pitfall to Avoid
The most critical error is failing to ask about lower abdominal pain and fever, as these symptoms indicate pelvic inflammatory disease rather than simple vaginitis—a distinction that dramatically changes management and prevents long-term morbidity including infertility 4. Additionally, 42% of women with vaginal symptoms receive inappropriate empiric treatment when proper symptom assessment is not performed, and those treated empirically without confirmed infection have significantly more return visits within 90 days 5.