Vulvovaginitis is the most common gynecologic problem for which women seek treatment. Symptoms may include vaginal discharge, vulvar pruritis and vaginal odor. The etiological agents responsible can commonly be identified in the office by obtaining an appropriate sample of the vaginal discharge for microscopic examination.
Bacterial vaginosis (BV) (Figure 7.1)
- Etiology. Overgrowth of several bacterial species in the vagina – specifically a decrease in lactobacilli and an increase in anaerobic organisms.
- Incidence. The most common cause of vaginitis in young women.
- Symptoms. Non-pruritic vaginal discharge with a “fishy” odor, but 50% of women are asymptomatic.
- Diagnosis. Positive KOH “whiff” test, pH >4.5, >20% clue cells on saline wet-mount, gray, homogeneous discharge (need three of four clinical criteria).
- Treatment. Oral/intravaginal metronidazole or clindamycin.
Candidiasis (Figure 7.1)
- Etiology. Over 200 strains of Candida albicans can colonize and cause vaginitis. It is unknown why Candida species is pathogenic in some women, but not in others.
- Incidence. The second most common cause of symptomatic vaginitis.
- Symptoms. Intense pruritus and vulvovaginal erythema.
- Diagnosis. KOH wet-mount to see the presence of branched and budding hyphae. Culture in Sabouraud medium may be indicated for selected cases.
- Treatment. topical clotrimazole (Canestin) or oral fluconazole (Diflucan).
Trichomoniasis (Figure 7.1)
- Etiology. Trichomonas vaginalis is an anaerobic protozoan and humans are the only known host.
- Incidence. This common sexually transmitted infection (STI) affects 180 million women worldwide.
- Symptoms. Profuse malodorous vaginal discharge, postcoital bleeding, vulvovaginal erythema.
- Diagnosis. Trichomonads seen on saline wet-mount are pathognomonic. Other features include an abundance of leukocytes and pH > 4.5. Organisms may be evident on a Pap smear in asymptomatic women.
- Treatment. Oral (not vaginal) metronidazole.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
