Bacterial vaginosis differential diagnosis

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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]

Differential Diagnosis

Bacterial vaginosis diagnosis is unlikely In the absence of microscopy,

• 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	Presents with purulent, malodorous, thin discharge associated with burning, pruritus, dysuria, inflammation with elevated vaginal pH (>4.5) Motile trichomonads on wet mount Positive culture (Gold standard) Positive nucleic acid amplification test (NAAT)
Atrophic vaginitis	Presents with dyspareunia or signs of vaginal inflammation with elevated vaginal pH (>4.5)
Desquamative inflammatory vaginitis	Presents with dyspareunia or signs of vaginal inflammation with elevated vaginal pH (>4.5)
Vaginal Candidiasis
Cervicitis

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

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