Approach to women with symptoms of vaginitis
- Jack D Sobel, MD
Jack D Sobel, MD
- Wayne State University School of Medicine
Vaginitis is the general term for disorders of the vagina caused by infection, inflammation, or changes in the normal vaginal flora. Symptoms include vaginal discharge, odor, pruritus, and/or discomfort. These symptoms are extremely common and frequently lead to self-diagnosis and therapy . In a telephone survey of random women in the United States, 8 percent of Caucasian women and 18 percent of African American women reported an episode of vaginal symptoms of any severity in the previous year . A healthcare professional was consulted in 55 and 83 percent of cases, respectively, and most women purchased an over-the-counter antifungal preparation to treat their symptoms, whether or not they saw a physician.
CAUSES OF VAGINITIS
The most common infections responsible for vaginal discharge, odor, pruritus, and/or discomfort are bacterial vaginosis, Candida vulvovaginitis, and trichomoniasis. These disorders account for over 90 percent of infections .
●(See "Bacterial vaginosis".)
●(See "Candida vulvovaginitis".)
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- CAUSES OF VAGINITIS
- PATIENT PRESENTATION
- GENERAL PRINCIPLES
- DIAGNOSTIC EVALUATION
- Physical examination
- Diagnostic studies
- - Vaginal pH
- - Microscopy
- Saline wet mount
- Potassium hydroxide wet mount
- - Amine test
- - Options when microscopy is not available
- - Vaginal culture or NAAT
- - Cervical culture
- WOMEN WITHOUT A DIAGNOSIS AFTER THE INITIAL EVALUATION
- General approach
- - Detailed history
- Irritants and allergens
- Menopausal women
- - Atrophic vaginitis
- - Intraepithelial neoplasia and cancer
- Pruritus, with a negative Candida culture
- - Cytolytic vaginosis
- Acute onset of purulent discharge and pain
- Serosanguinous discharge and pelvic pain
- Chronic introital pain as a primary symptom
- Postcoital vulvovaginal pruritus and pain
- Desquamative inflammatory vaginitis
- Persistent genital malodor
- - Group B streptococcus
- - "Non-specific bacterial vaginitis"
- POSTDIAGNOSTIC MANAGEMENT
- MANAGEMENT OF PHYSIOLOGICAL LEUKORRHEA
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS