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Backround  Vaginitis is among the most common conditions women are seeking medical care for. Although these infections can easily be treated, the relapse rate is high. This may be due to inadequate use of the diagnostic potential.    Methods  We evaluated the misjudgement rate of the aetiology of vaginal complaints. A total of 220 vaginal samples from women with a vaginal complaint were obtained and analysed for numbers of total lactobacilli, H 2 O 2 -producing lactobacilli, total aerobic cell counts and total anaerobic cell counts including bifidobacteria,  Bacteroides  spp.,  Prevotella  spp. Additionally, the presence of  Atopobium vaginae ,  Gardnerella vaginalis ,  Candida  spp. and  Trichomonas vaginalis  was evaluated by DNA-hybridisation using the PCR and Affirm VPIII Microbial Identification Test, respectively.    Results  The participating physicians diagnosed Bacterial vaginosis (BV) as origin of discomfort in 80 cases, candidiasis in 109 cases and mixed infections in 8 cases. However, a present BV, defined as lack of H 2 O 2 -lactobacilli, presence of marker organisms, such as  G. vaginalis ,  Bacteroides  spp. or  Atopobium vaginae , and an elevated pH were identified in only 45 cases of the women examined.  Candida  spp. were detected in 46 cases. Interestingly, an elevated pH corresponded solely to the presence of  Atopobium vaginae , which was detected in 11 cases.    Conclusion  Errors in the diagnosis of BV and candida vulvovaginitis (CV) were high. Interestingly, the cases of misjudgement of CV (77%) were more numerous than that of BV (61%). The use of Amsel criteria or microscopy did not reduce the number of misinterpretations. The study reveals that the misdiagnosis of vaginal complaints is rather high.

Throwing the dice for the diagnosis of vaginal complaints?