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We do a few genital cultures still, and the physician is good about including the diagnosis. But I've been concerned about the situation in which the genital smear suggests bacterial vaginosis (no Lacto, many small variable rods and rare yeast), but then the culture grows many yeast. We then feel obligated to ID the yeast, but actually the gram stain suggested yeast was a minor presence. When the gram stain shows rare yeast, should we limit our yeast workup? Possibly report as "Many yeast, no further ID indicated by original smear." In this case, the dx was polycystic ovaries. Thanks.
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As you well know, the three primary vaginal syndromes are vulvovaginal candidiasis (aka yeast vaginitis), trichomoniasis, and bacterial vaginosis. Interestingly, 25% of women will have 2 or, rarely, 3 concurrent syndromes. What you are describing is a woman who has both BV and VVC(YV).
The shortcoming of wet mount or Gram stain for VVC(YV) is one of poor sensitivity (~50%), not specificity. The presence of yeast on microscopic exam makes the diagnosis of VVC(YV). If yeast are seen on smear, I don't routinely recommend culture confirmation. In women with rare episodes, it is Candida albicans 95% of the time. Identification to species may be helpful (by request) in women with recurrent VVC(YV) because they are more likely infected with candida that are more resistant to eradication. Antifungal susceptibility testing is not recommended, however, because it doesn't impact outcome.
It appears your patient had BV and VVC(YV) in addition to polycyctic ovaries.
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