Vaginitis: Difference between revisions
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||✔ ||✔✔ | ||✔ ||✔✔ | ||
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*Vulvar edema, [[fissures]], excoriations | *Vulvar edema, [[fissures]], [[excoriations]] | ||
*Thick, [[curdy]] [[vaginal discharge]] | *Thick, [[curdy]] [[vaginal discharge]] | ||
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* Fishy odor from the [[vagina]] | * Fishy odor from the [[vagina]] | ||
* Thin, white/gray homogeneous [[vaginal discharge]] | * Thin, white/gray homogeneous [[vaginal discharge]] | ||
* Lack of significant vulvovaginal inflammation | * Lack of significant vulvovaginal [[inflammation]] | ||
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| [[Trichomoniasis]] ||✔||✔|| ✔ | | [[Trichomoniasis]] ||✔||✔|| ✔ | ||
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* Strawberry [[cervix]]: petechial haemorrhages on the [[ectocervix]], specific to [[trichomoniasis]] | * Strawberry [[cervix]]: [[petechial haemorrhages]] on the [[ectocervix]], specific to [[trichomoniasis]] | ||
* Frothy, [[mucopurulent]], yellow-green or gray [[vaginal discharge]] | * Frothy, [[mucopurulent]], yellow-green or gray [[vaginal discharge]] | ||
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*Pale and dry vaginal mucosa | *Pale and dry vaginal mucosa | ||
*Increased friability of the vaginal mucosa with patchy [[erythema]] and [[petechiae]] | *Increased [[friability]] of the [[vaginal]] [[mucosa]] with patchy [[erythema]] and [[petechiae]] | ||
*Sparsity of pubic hair, fusion of the [[labia minora]], narrow and a shortened vagina | *Sparsity of [[pubic hair]], fusion of the [[labia minora]], narrow and a shortened [[vagina]] | ||
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|Aerobic Vaginitis | |Aerobic Vaginitis | ||
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*[[Vaginal mucosa]] is red and [[inflamed]], severe [[ecchymotic]] bleeding points and [[ulcers]] can be seen in severe cases | *[[Vaginal mucosa]] is red and [[inflamed]], severe [[ecchymotic]] bleeding points and [[ulcers]] can be seen in severe cases | ||
*Erosions, [[hyperaemia]], scattered bleeding points and [[ulcers]] can be demonstrated on the [[cervix]] | *[[Erosions]], [[hyperaemia]], scattered [[bleeding points]] and [[ulcers]] can be demonstrated on the [[cervix]] | ||
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| rowspan="2" |'''Cervicitis''' | | rowspan="2" |'''Cervicitis''' | ||
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*Cloudy, yellow mucoid discharge from the cervical os<ref name="pmid16669564">{{cite journal| author=Miller KE| title=Diagnosis and treatment of Chlamydia trachomatis infection. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 8 | pages= 1411-6 | pmid=16669564 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16669564 }}</ref> | *Cloudy, yellow mucoid [[discharge]] from the [[cervical os]]<ref name="pmid16669564">{{cite journal| author=Miller KE| title=Diagnosis and treatment of Chlamydia trachomatis infection. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 8 | pages= 1411-6 | pmid=16669564 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16669564 }}</ref> | ||
*Friable appearance of [[cervix]] | *Friable appearance of [[cervix]] | ||
*[[Cervical motion tenderness]] may be present<ref name="abc">Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on January 11, 2016</ref> | *[[Cervical motion tenderness]] may be present<ref name="abc">Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on January 11, 2016</ref> | ||
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**Lower [[abdominal pain]] (consistent with [[PID]]) | **Lower [[abdominal pain]] (consistent with [[PID]]) | ||
**Right upper quadrant pain ([[Fitz-Hugh-Curtis syndrome]]) | **Right upper quadrant pain ([[Fitz-Hugh-Curtis syndrome]]) | ||
*Labial edema and Bartholin’s gland enlargement and tenderness [[Bartholinitis|(Bartholinitis]]) | *[[Labial edema ]]and [[Bartholin’s]] gland enlargement and tenderness [[Bartholinitis|(Bartholinitis]]) | ||
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Revision as of 19:03, 30 March 2017
For patient information click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2], Dima Nimri, M.D. [3], Aravind Kuchkuntla, M.B.B.S[4]
Overview
Vulvovaginitis, a common condition for which women seek medical care, accounts for greater than 10% of visits made to providers of women's health care.[1] It is characterized by symptoms that cause itching, irritation, burning, and abnormal vaginal discharge. The three most common causes of vaginal discharge in women within the reproductive age group are bacterial vaginosis, candida vulvovaginitis, and trichomoniasis. All patients with vulvovaginitis present with common symptoms like vaginal discharge, itching, and dysuria. Diagnosis of vulvovaginitis requires a detailed history of the patient's symptoms, as well as her sexual history, both of which facilitate an accurate diagnosis. Physical examination of the external genitalia and speculum examination should focus on documenting the nature of the discharge, the presence of any vulvar or labial lesions, foreign body, presence of cervical inflammation, cervical lesions, and any cervical motion or adnexal tenderness with a bimanual examination. It is essential to rule out pelvic inflammatory disease and cervical lesions as the cause of vaginal discharge. Estimation of vaginal pH and vaginal smear wet mount examination constitute the initial diagnostic test, which helps differentiate among common etiologies. Treatment of vulvovaginitis includes medical therapy targeted against the causative pathogen and counseling on hygiene, voiding techniques, and sexual practices. The prognosis is good in most patients, though a minority of patients experience recurrence.
Classification
Based on the etiology vaginitis is classified into the following:
- Candida Vulvovaginitis
- Bacterial vaginosis
- Trichomoniasis
- Atrophic vaginitis
- Aerobic vagnitis
Differential Diagnosis
The differential diagnosis for patients presenting with vaginal discharge includes the following considerations:
Common Presentation | Disease | Symptoms | Physical Examination Findings | |||||
---|---|---|---|---|---|---|---|---|
Discharge | Dysuria | Vaginal odor | Dyspareunia | Genital skin lesion | Genital pruritus | |||
Vaginitis | Candida Vulvovaginitis | ✔ | ✔ | ✔ | ✔ | ✔ | ✔✔ |
|
Bacterial Vaginosis | ✔ | — | ✔ | — | — | — |
| |
Trichomoniasis | ✔ | ✔ | ✔ | ✔ | — | ✔ |
| |
Atrophic Vaginitis | ✔ | ✔ | ✔ | ✔✔ | ✔ | ✔ |
| |
Aerobic Vaginitis | ✔ | ✔ | ✔ | ✔ | — | ✔ |
| |
Cervicitis | Chlamydia | ✔ | ✔ | ✔ | — | ✔ |
| |
Gonorrhea | ✔ | ✔ | ✔ | ✔ | — | — |
|
Diagnosis and Treatment
The following table summarizes the diagnosis and management of common vaginitis conditions:[4]
Disease | Investigation | Diagnostic Approach | Treatment | ||
---|---|---|---|---|---|
pH | Saline Wet mount preparation | Gold Standard test | |||
Candida Vulvovaginitis | Normal | Hyphae and pseudohyphae can be demonstrated | Culture |
|
|
Bacterial Vaginosis | >4.5 | Clue cells are demonstrated | Gram stain to determine the relative concentration of lactobacilli, G. vaginalis, Prevotella, Porphyromonas, peptostreptococci and Mobiluncus |
Amsel’s criteria: Presence of three out of four criteria is required to make the diagnosis of BV
|
|
Trichomoniasis | >4.5 |
|
Nucleic acid amplification test (NAAT) |
|
|
Atrophic Vaginitis | Normal | Vaginal smear cytology shows increased parabasal cells | Leftward shift of the vaginal maturation index |
|
|
Aerobic Vaginitis | Increased
>6 |
Numerous leukocytes are present | No gold standard confirmative test but excessive growth of aerobes on culture helps in diagnosis when the vaginal smear findings are indeterminate | Microscopic diagnosis is made by Lactobacillus grade (LBG) and the severity is scored based on number of leukocytes, proportion of toxic leukocytes and parabasal epitheliocytes, and background flora |
|
References
- ↑ Quan M (2010). "Vaginitis: diagnosis and management". Postgrad Med. 122 (6): 117–27. doi:10.3810/pgm.2010.11.2229. PMID 21084788.
- ↑ Miller KE (2006). "Diagnosis and treatment of Chlamydia trachomatis infection". Am Fam Physician. 73 (8): 1411–6. PMID 16669564.
- ↑ Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on January 11, 2016
- ↑ Workowski KA, Bolan GA, Centers for Disease Control and Prevention (2015). "Sexually transmitted diseases treatment guidelines, 2015". MMWR Recomm Rep. 64 (RR-03): 1–137. PMID 26042815.