Bacterial vaginosis differential diagnosis: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
Bacterial vaginosis diagnosis is unlikely In the absence of microscopy, | Bacterial vaginosis diagnosis is unlikely In the absence of microscopy, | ||
<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> | |||
*A lack of fishy odor (negative whiff test) makes the diagnosis of bacterial vaginosis (BV) unlikely. | *A lack of fishy odor (negative whiff test) makes the diagnosis of bacterial vaginosis (BV) unlikely. | ||
*Normal vaginal PH (<4.5). Other causes of increased [[pH]] include | *Normal vaginal PH (<4.5). Other causes of increased [[pH]] include | ||
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| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Trichomoniasis]]''' | | style="padding: 5px 5px; background: #DCDCDC;" |'''[[Trichomoniasis]]''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Presents with purulent, malodorous, thin discharge associated with burning, pruritus, dysuria, [[inflammation]] | *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 | *Motile trichomonads on wet mount | ||
*Positive culture (Gold standard) | *Positive culture (Gold standard) | ||
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| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Atrophic vaginitis]]''' | | style="padding: 5px 5px; background: #DCDCDC;" |'''[[Atrophic vaginitis]]''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Presents with [[dyspareunia]] | *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: #DCDCDC;" | '''Desquamative inflammatory vaginitis''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Presents with [[dyspareunia]] or | *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;" | '''[[Vaginal Candidiasis]]''' | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Vaginal Candidiasis]]''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | 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) | |||
|} | |} | ||
trichomoniasis, atrophic vaginitis, and desquamative inflammatory vaginitis. These four entities are easily distinguishable by clinical and microscopic features. | trichomoniasis, atrophic vaginitis, and desquamative inflammatory vaginitis. These four entities are easily distinguishable by clinical and microscopic features. | ||
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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
Differential Diagnosis
Bacterial vaginosis diagnosis is unlikely In the absence of microscopy, [1][2][3]
- A lack of fishy odor (negative whiff test) makes the diagnosis of bacterial vaginosis (BV) unlikely.
- Normal vaginal PH (<4.5). Other causes of increased pH include
- Presents of dysuria
- signs of inflammation in vagina
| Disease | Findings |
|---|---|
| Trichomoniasis |
|
| Atrophic vaginitis |
|
| Desquamative inflammatory vaginitis |
|
| Vaginal Candidiasis |
|
trichomoniasis, atrophic vaginitis, and desquamative inflammatory vaginitis. These four entities are easily distinguishable by clinical and microscopic features.
●Women with BV do not have dyspareunia or signs of vaginal inflammation; in contrast, women with atrophic vaginitis, desquamative inflammatory vaginitis, and trichomoniasis usually have these signs and symptoms. ●Both atrophic vaginitis and desquamative inflammatory vaginitis are associated with an increased number of parabasal cells on microscopy, which is not observed in women with BV. ●A large number of polymorphonuclear leukocytes on microscopy are characteristic of desquamative inflammatory vaginitis, trichomoniasis, and atrophic vaginitis with infection, but not BV. ●Visualization of trichomonads readily makes the diagnosis of trichomoniasis in the setting of an elevated pH, however, in other cases, we suggest using more sensitive and specific diagnostic tests to diagnose or exclude trichomoniasis.
References
- ↑ Bachmann GA, Nevadunsky NS (2000). "Diagnosis and treatment of atrophic vaginitis". Am Fam Physician. 61 (10): 3090–6. PMID 10839558.
- ↑ 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.
- ↑ 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.