Vaginal infections are one of the most common reasons for medical healthcare visits in the United States and Western Europe. These diseases are also significantly associated with HIV acquisition in resource-constrained settings throughout the world. However, despite ample opportunity to improve diagnosis, and therefore management, of vaginitis and vaginosis, the healthcare community continues to rely on diagnostic methods with poor performance characteristics. This state of affairs results in part from the lack of a public health mandate to reduce the burden of these infections in women. Without such a mandate, there is a lack of funding for reimbursement for more sensitive and specific diagnostic assays. Sensitive assays do exist for these infections, and their use should be encouraged when appropriate for clinical care. © Springer Science+Business Media LLC 2010.