Vaginitis
Evaluation
General—inflammation of the vagina
Etiology
Bacterial vaginosis (40%-50% of cases)
Clinical—adherent and malodorous (“fishy”) off-white discharge
NO dyspareunia, pruritus, or inflammation; many ♀ are asymptomatic.
Etiology—change in vaginal flora
Decrease in normal vaginal bacteria (lactobacillus)
Increase in Gardnerella vaginalis, and so on.
Epidemiology—most common type of vaginitis in child-bearing women
Risk factors—nonwhite, previous pregnancy, intrauterine device (IUD)
Diagnosis—increase in vaginal pH (” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1bf60323fbcd0e1aa41c5e0a207dc2da4a}/ID(AB1-M10)”>>4.5), clue cells (epithelial cells covered with bacteria)
No need for culture.
Treatment
Recurrent bacterial vaginosis
General—approximately 30% who previously responded have recurrence in 3 months
Treatment—10 to 14 days of therapy is required for symptomatic relapse.
Complications
Increased risk of premature birth (15%-20% pregnant women affected).
Consider checking human immunodeficiency virus (HIV) status in these patients.
Candidal vulvovaginitis (20%-25% of cases)
Clinical—pruritus, vaginal discomfort, curd-like discharge, and painful coitus
White plaques on vaginal walls, vulvar erythema, and edema
Etiology—Candida albicans (80%-92%), Candida glabrata
Epidemiology—common in women of child-bearing age
Risk factors—diabetes, antibiotics, steroids, HIV, ↑ estrogen levels (oral contraceptive pills [OCPs], pregnancy)
Also, vaginal sponge and IUD
Diagnosis—normal vaginal pH (4.0-4.5), pseudohyphae on 10% potassium hydroxide (KOH)
Treatment
Clotrimazole vaginal creams
