Approximately 347,000 women serve in the U.S. military, and regularly deploy to austere military environments where harsh climate and terrain, primitive hygiene facilities, and unavailable or unacceptable health care resources for women increase women's risk for development of vaginitis and urinary tract infections (UTI). Untreated or inadequately treated symptoms of bacterial vaginosis, trichomonas vaginitis, candida vaginitis, and UTI are miserable, embarrassing, distracting and significantly interfere with women's quality of life, comfort, and concentration. In deployment situations, a viable solution to the problem is a field-expedient kit for self-diagnosis and self-treatment of these symptoms. Preliminary work supports the need for such a kit and the feasibility of developing a kit that is user-friendly, sensitive and specific. In this study, 1560 Army and Navy women who seek care from a military clinic for vaginal or urinary symptoms, will conduct a self-diagnosis using a Decision-Making Guide and selected materials to measure vaginal and urinary symptoms, and vaginal pH and amines. We will test the sensitivity and specificity of military women's self- diagnoses in comparison with laboratory reference standards (urine culture and DNA probe testing for gardnerella vaginalis, trichomonas vaginalis, and candida species). A research advanced practice nurse (APN) will enroll women in the study, conduct a protocol-driven clinical diagnostic examination, and treat the women with selected single-dose oral medications that will ultimately be included in the field-expedient self-care kit. The women's observations on the Decision-Making Guide will be compared with the APN's clinical observations to evaluate the extent to which each item in the Guide contributes to the true diagnosis. We will also estimate the frequency with which women would have made an error in self-treatment based on their self- diagnoses if they had used this kit during deployment. The women will return to the clinic for follow-up visits with the APN in order to evaluate their satisfaction with the self-diagnosis process and the single-dose oral treatment of their symptoms, and for their recommendations for improvement of the kit. While this proposed research focuses on a self-care intervention for military women, it has a much broader potential for use by civilian women who find themselves in austere environments for other reasons, i.e. missionary work, Peace Corps, humanitarian missions, expeditions, or foreign travel.
| Ryan-Wenger, Nancy A; Neal, Jeremy L; Jones, Ashley S et al. (2010) Accuracy of vaginal symptom self-diagnosis algorithms for deployed military women. Nurs Res 59:2-10 |
| Lowe, Nancy K; Neal, Jeremy L; Ryan-Wenger, Nancy A (2009) Accuracy of the clinical diagnosis of vaginitis compared with a DNA probe laboratory standard. Obstet Gynecol 113:89-95 |
| Lowe, Nancy K; Ryan-Wenger, Nancy A (2006) Factors associated with vaginal douching in military women. Mil Med 171:1015-9 |
