Bacterial vaginosis differential diagnosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Bacterial vaginosis}} | {{Bacterial vaginosis}} | ||
{{CMG}}; {{AE}} {{SaraM}} | |||
==Overview== | |||
Bacterial vaginosis must be differentiated from other diseases that cause purulent, malodorous, thin [[vaginal discharge]] with elevated vaginal pH (<4.5). Such diseases include [[trichomoniasis]], [[atrophic vaginitis]], and desquamative inflammatory vaginitis. Additionally, bacterial vaginosis also must be differentiated other conditions such as [[candidiasis|vaginal candidiasis]], [[vaginitis]], and [[cervicitis]].<ref name=CDC-BV> Centers for Disease Control and Prevention. 2015 Sexually Transmitted Diseases Treatment Guidelines. Bacterial Vaginosis. http://www.cdc.gov/std/tg2015/bv.htm Accessed on October 13, 2016 </ref><ref name="pmid10839558">{{cite journal| author=Bachmann GA, Nevadunsky NS| title=Diagnosis and treatment of atrophic vaginitis. | journal=Am Fam Physician | year= 2000 | volume= 61 | issue= 10 | pages= 3090-6 | pmid=10839558 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10839558 }} </ref><ref name="pmid2448502">{{cite journal| author=Krieger JN, Tam MR, Stevens CE, Nielsen IO, Hale J, Kiviat NB et al.| title=Diagnosis of trichomoniasis. Comparison of conventional wet-mount examination with cytologic studies, cultures, and monoclonal antibody staining of direct specimens. | journal=JAMA | year= 1988 | volume= 259 | issue= 8 | pages= 1223-7 | pmid=2448502 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2448502 }} </ref><ref name="pmid21422855">{{cite journal| author=Sobel JD, Reichman O, Misra D, Yoo W| title=Prognosis and treatment of desquamative inflammatory vaginitis. | journal=Obstet Gynecol | year= 2011 | volume= 117 | issue= 4 | pages= 850-5 | pmid=21422855 | doi=10.1097/AOG.0b013e3182117c9e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21422855 }} </ref><ref name="pmid9794664">{{cite journal| author=Eckert LO, Hawes SE, Stevens CE, Koutsky LA, Eschenbach DA, Holmes KK| title=Vulvovaginal candidiasis: clinical manifestations, risk factors, management algorithm. | journal=Obstet Gynecol | year= 1998 | volume= 92 | issue= 5 | pages= 757-65 | pmid=9794664 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9794664 }} </ref> | |||
==Differential Diagnosis== | |||
A diagnosis of bacterial vaginosis is unlikely in the absence of the following findings: | |||
*Fishy odor (negative whiff test) | |||
*Normal vaginal pH (<4.5) | |||
*Presence of [[dysuria]] | |||
*Signs of vaginal [[inflammation]] | |||
Bacterial vaginosis must be differentiated from:<ref name=CDC-BV> Centers for Disease Control and Prevention. 2015 Sexually Transmitted Diseases Treatment Guidelines. Bacterial Vaginosis. http://www.cdc.gov/std/tg2015/bv.htm Accessed on October 13, 2016 </ref><ref name="pmid10839558">{{cite journal| author=Bachmann GA, Nevadunsky NS| title=Diagnosis and treatment of atrophic vaginitis. | journal=Am Fam Physician | year= 2000 | volume= 61 | issue= 10 | pages= 3090-6 | pmid=10839558 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10839558 }} </ref><ref name="pmid2448502">{{cite journal| author=Krieger JN, Tam MR, Stevens CE, Nielsen IO, Hale J, Kiviat NB et al.| title=Diagnosis of trichomoniasis. Comparison of conventional wet-mount examination with cytologic studies, cultures, and monoclonal antibody staining of direct specimens. | journal=JAMA | year= 1988 | volume= 259 | issue= 8 | pages= 1223-7 | pmid=2448502 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2448502 }} </ref><ref name="pmid21422855">{{cite journal| author=Sobel JD, Reichman O, Misra D, Yoo W| title=Prognosis and treatment of desquamative inflammatory vaginitis. | journal=Obstet Gynecol | year= 2011 | volume= 117 | issue= 4 | pages= 850-5 | pmid=21422855 | doi=10.1097/AOG.0b013e3182117c9e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21422855 }} </ref><ref name="pmid9794664">{{cite journal| author=Eckert LO, Hawes SE, Stevens CE, Koutsky LA, Eschenbach DA, Holmes KK| title=Vulvovaginal candidiasis: clinical manifestations, risk factors, management algorithm. | journal=Obstet Gynecol | year= 1998 | volume= 92 | issue= 5 | pages= 757-65 | pmid=9794664 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9794664 }} </ref> | |||
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center | |||
|+ | |||
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Disease}} | |||
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}} | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Trichomoniasis]]''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*Presents with purulent, malodorous, thin discharge associated with burning, [[pruritus]], and [[dysuria]], with the sign of vaginal [[inflammation]] and elevated vaginal [[pH]] (>4.5) | |||
*Motile trichomonads on wet mount | |||
*Positive culture (Gold standard) | |||
*Positive nucleic acid amplification test (NAAT) | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Atrophic vaginitis]]''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*Progressive symptoms | |||
*Presents with yellow and malodorous vaginal discharge, vaginal dryness, postcoital bleeding, and [[dyspareunia]] with the sign of vaginal [[inflammation]] and elevated vaginal pH (>5) | |||
*Diagnosis is critical and laboratory tests can confirm hypoestrogenic state | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" | '''Desquamative inflammatory vaginitis''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*Chronic clinical syndrome with unknown etiology | |||
*Presents with [[dyspareunia]], dyspareunia, yellow, grey, or green profuse vaginal discharge with the sign of vaginal [[inflammation]] and elevated vaginal pH (>4.5) | |||
*Microscopy shows large number of parabasal (immature squamous epithelial cells) and inflammatory cells | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[candidiasis|Vaginal candidiasis]]''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*Presents with vulvar pruritus and cottage cheese-like vaginal discharge with no or minimal odor with normal vaginal pH (4-4.5) | |||
*presence of [[Candida]] on wet mount (adding 10% KOH destroys the cellular elements and facilitates recognition of budding yeast, pseudohyphae, and hyphae) | |||
|} | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} {{WS}} | |||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Up-To-Date]] | |||
[[Category:Gynecology]] | [[Category:Gynecology]] | ||
[[Category:Emergency medicine]] | |||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
Latest revision as of 20:34, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]
Overview
Bacterial vaginosis must be differentiated from other diseases that cause purulent, malodorous, thin vaginal discharge with elevated vaginal pH (<4.5). Such diseases include trichomoniasis, atrophic vaginitis, and desquamative inflammatory vaginitis. Additionally, bacterial vaginosis also must be differentiated other conditions such as vaginal candidiasis, vaginitis, and cervicitis.[1][2][3][4][5]
Differential Diagnosis
A diagnosis of bacterial vaginosis is unlikely in the absence of the following findings:
- Fishy odor (negative whiff test)
- Normal vaginal pH (<4.5)
- Presence of dysuria
- Signs of vaginal inflammation
Bacterial vaginosis must be differentiated from:[1][2][3][4][5]
| Disease | Findings |
|---|---|
| Trichomoniasis |
|
| Atrophic vaginitis |
|
| Desquamative inflammatory vaginitis |
|
| Vaginal candidiasis |
|
References
- ↑ 1.0 1.1 Centers for Disease Control and Prevention. 2015 Sexually Transmitted Diseases Treatment Guidelines. Bacterial Vaginosis. http://www.cdc.gov/std/tg2015/bv.htm Accessed on October 13, 2016
- ↑ 2.0 2.1 Bachmann GA, Nevadunsky NS (2000). "Diagnosis and treatment of atrophic vaginitis". Am Fam Physician. 61 (10): 3090–6. PMID 10839558.
- ↑ 3.0 3.1 Krieger JN, Tam MR, Stevens CE, Nielsen IO, Hale J, Kiviat NB; et al. (1988). "Diagnosis of trichomoniasis. Comparison of conventional wet-mount examination with cytologic studies, cultures, and monoclonal antibody staining of direct specimens". JAMA. 259 (8): 1223–7. PMID 2448502.
- ↑ 4.0 4.1 Sobel JD, Reichman O, Misra D, Yoo W (2011). "Prognosis and treatment of desquamative inflammatory vaginitis". Obstet Gynecol. 117 (4): 850–5. doi:10.1097/AOG.0b013e3182117c9e. PMID 21422855.
- ↑ 5.0 5.1 Eckert LO, Hawes SE, Stevens CE, Koutsky LA, Eschenbach DA, Holmes KK (1998). "Vulvovaginal candidiasis: clinical manifestations, risk factors, management algorithm". Obstet Gynecol. 92 (5): 757–65. PMID 9794664.