{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T11:43:20Z","timestamp":1782992600654,"version":"3.54.5"},"reference-count":25,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Abnormal vaginal discharge (AVD) is a common complaint among women of reproductive age, often involving multiple, overlapping etiologies, most commonly bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), aerobic vaginitis (AV), and sexually transmitted infections (STIs). We aimed to evaluate a syndromic diagnostic approach by developing qPCR-derived dysbiosis indices for BV, VVC, and AV, subsequently comparing their performance against established reference methods and clinician-assigned diagnoses. Methods: Vaginal swabs were collected in a case\u2013control design from 74 symptomatic and 64 asymptomatic women at two clinics in Slovenia. Commercial qPCR assays quantified the microbial species associated with AVD. Relative abundances were integrated into novel dysbiosis indices. Diagnostic performance was validated against the Nugent scoring system (for BV), semiquantitative Candida culture with clinical symptoms (for VVC), and Hay\u2013Ison criteria (for AV). Results: In this internally validated study, dysbiosis indices demonstrated high agreement with their respective reference tests and outperformed clinician-assigned diagnoses across all three conditions. The syndromic approach further revealed that mixed etiologies were frequent, leading to a diagnostic resolution for this patient subset. Conclusions: qPCR-based microbial dysbiosis indices offer a robust alternative to microscopy, particularly in settings where microscopy is not routinely performed. This method improves the accuracy of AVD evaluation and supports more targeted clinical management.<\/jats:p>","DOI":"10.3390\/diagnostics16132075","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T10:04:44Z","timestamp":1782986684000},"page":"2075","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comprehensive Diagnosis of Abnormal Vaginal Discharge Using qPCR-Based Microbial Dysbiosis Indices"],"prefix":"10.3390","volume":"16","author":[{"given":"Petra","family":"Vovko","sequence":"first","affiliation":[{"name":"Department of Medical Microbiology, National Laboratory of Health, Environment and Food, Mej vrti 5, 8000 Novo Mesto, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vesna","family":"Fabjan Vodu\u0161ek","sequence":"additional","affiliation":[{"name":"Department of Perinatology, Division of Gynecology, University Medical Center Ljubljana, \u0160lajmerjeva 3, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matja\u017e","family":"Retelj","sequence":"additional","affiliation":[{"name":"Department for Microbiological Analysis of Food, Water, and Other Environmental Samples, National Laboratory of Health, Environment and Food, Mej vrti 5, 8000 Novo Mesto, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Sodec","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, National Laboratory of Health, Environment and Food, Mej vrti 5, 8000 Novo Mesto, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Bu\u010dar","sequence":"additional","affiliation":[{"name":"Community Health Center Novo Mesto, Kandijska Cesta 4, 8000 Novo Mesto, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasna","family":"Kostanj\u0161ek","sequence":"additional","affiliation":[{"name":"Community Health Center Novo Mesto, Kandijska Cesta 4, 8000 Novo Mesto, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marijana","family":"Klari\u010d Kamin","sequence":"additional","affiliation":[{"name":"Community Health Center Novo Mesto, Kandijska Cesta 4, 8000 Novo Mesto, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronika","family":"Testen","sequence":"additional","affiliation":[{"name":"Community Health Center Novo Mesto, Kandijska Cesta 4, 8000 Novo Mesto, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nata\u0161a","family":"Tul Mandi\u0107","sequence":"additional","affiliation":[{"name":"Department of Perinatology, Division of Gynecology, University Medical Center Ljubljana, \u0160lajmerjeva 3, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1001\/jama.291.11.1368","article-title":"Evaluation of Vaginal Complaints","volume":"291","author":"Anderson","year":"2004","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/s11908-015-0488-3","article-title":"The Role of PCR in the Diagnosis of Candida Vulvovaginitis\u2014A New Gold Standard?","volume":"17","author":"Sobel","year":"2015","journal-title":"Curr. 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