Review Question - QID 103318

Vaginitis presents with vaginal itching, burning, irritation, odor and vaginal discharge. Common causes of vaginitis include candida, BV, trichomonas, and allergic contact dermatitis.

Vaginitis is among the most common conditions for women to seek medical care. To determine the cause of vaginitis, assessment should include speculum examination, pH testing, wet-mount and potassium hydroxide (KOH) preparations, and cultures (e.g.: gonorrhea and chlamydia) when indicated. Condyloma lata is a cutaneous, not intravaginal, condition that presents as warty white to gray plaques in the genital area and perineum and is often associated with secondary syphilis.

Hainer et al. discuss the diagnostic criteria for BV (Amsel criteria) which include: (1) vaginal pH >4.5, (2) positive whiff test for fishy odor, (3) milky discharge and (4) presence of clue cells on microscopic examination (Illustration A). Amsel criteria is has a sensitivity of 69% and a specificity of 93%. Treatment of BV is with metronidazole or clindamycin. In contrast trichomoniasis is based on microscopic visualization of parasites (Illustration B). Treatment of trichomonas is with metronidazole or nitroimidazole. Since trichomonas is a sexually transmitted infection, sex partners should be treated simultaneously.

Owen et al. discuss the predominant symptoms in vulvovaginal candiasis include pruritis (50%), swelling (24%) and dysuria (33%). Characteristic vaginal discharge is usually thick and white. Diagnosis is confirmed by microscopic examination with KOH preparation of the fungal organism. Treatment of vulvovaginal candidiasis is with fluconazole or clomitrazole.

Illustration A demonstrates a wet mount clue cell, which is a vaginal epithelial cell with borders obscured by adherent bacteria. Illustration B demonstrates trichomonas vaginalis infestation on a pap smear. Illustration C demonstrates budding yeast of candida species

Incorrect answers:
Answers 1,2,3: BV, vulvovaginal candiasis and trichomonas are the three most common causes of infectious vaginitis.
Answer 4: Allergic contact dermatitis is a noninfectious cause of vaginitis that may be associated with use of feminine hygiene products or contraceptive materials.