II. Epidemiology

  1. Chronic vaginal symptoms in 105 women surveyed
    1. Women often self-treat chronic vaginal symptoms
      1. Over-the-counter yeast Vaginitis medication: 73%
      2. Alternative Medicine yeast Vaginitis treatment: 42%
    2. Self-diagnosis often incorrect and may be harmful
      1. Correct diagnosis of yeast Vaginitis: 11-28%
      2. Secondary irritant Vaginitis: 15%
  2. References
    1. Ferris (1996) J Fam Pract 42:595-600 [PubMed]
    2. Nyrirjesy (1997) Obstet Gynecol 90:50-3 [PubMed]

III. Physiology: Normal vaginal secretions

  1. Variably dependent on multiple factors
    1. Age
    2. Timing of Menstrual Cycle
    3. Sexual arousal
    4. Contraceptive use
    5. Douching
  2. Derivation
    1. Cervical Mucus
    2. Vaginal wall transudate
    3. Exfoliated vaginal cells

IV. Causes

  1. Common
    1. Normal discharge (30%)
    2. Candida Vulvovaginitis (20-25%)
    3. Bacterial Vaginosis (23-50%)
    4. Trichomonas Vaginitis (5-15%)
    5. Mixed infection or Sexually Transmitted Disease (20%)
      1. See Cervicitis
  2. Uncommon
    1. Mycoplasma genitalium
    2. Ureaplasma urealyticum

V. Causes: Other

  1. Atrophic Vaginitis (post-menopausal women)
  2. Infectious Cervicitis
    1. Neisseria gonorrhoeae
    2. Chlamydia trachomatis
    3. Herpes Simplex Virus
  3. Vaginitis or Vulvitis
    1. Scabies
    2. Neurodermatitis
    3. Vaginal or vulvar Trauma
    4. Lichen Planus
    5. Vulvar Vestibulitis
    6. Herpes Vulvitis
    7. Malignancy
    8. Irritant Contact Vaginitis
      1. Soaps
      2. Tampons or sanitary napkins
      3. Condoms
      4. Spermicidal gel
      5. Diaphragm
      6. Dyes
  4. Physiologic discharge
    1. Ovulation
    2. Pregnancy

VI. History: Rule out Sexually Transmitted Disease

  1. Multiple sexual partners
  2. Intrauterine Device or no Contraception
  3. History of Sexually Transmitted Disease

VII. Symptoms

  1. Vaginal itching or burning: Candida Vulvovaginitis
    1. Absence of itching makes Vulvovaginal Candidiasis unlikely
  2. Perceived odor (especially fishy): Bacterial Vaginosis
    1. Absence of odor makes Bacterial Vaginosis unlikely, and Candida Vulvovaginitis more likely
  3. Inflammatory signs and symptoms: Candida Vulvovaginitis
  4. Malodorous or unusual Vaginal Discharge
  5. External Dysuria (pain with urine passing over vulva)
  6. Dyspareunia

VIII. Signs

  1. See Vaginal pH
  2. Character of vaginal secretions
    1. Normal: clear or white, non-clumping, odorless
    2. Dry cottage cheese-like discharge
      1. Candida Vulvovaginitis
    3. Frothy discharge (rarely present)
      1. Trichomonas Vaginitis
    4. Fishy Odor
      1. Bacterial Vaginosis
      2. Trichomonas Vaginitis
  3. Vagina and Cervix appearance
    1. Vulvar redness, edema and adherent white clumps
      1. Candida Vulvovaginitis
    2. Strawberry Cervix with punctate Hemorrhage
      1. Trichomonas Vaginitis
    3. Pale, dry, thin vaginal and vulvar skin
      1. Atrophic Vaginitis

IX. Labs: Microscopy

  1. Normal
    1. Few Polymorphonuclear Leukocytes (PMNs)
    2. Vaginal epithelial cells
  2. KOH Preparation: Pseudo-hyphae or budding yeast
    1. Candida Vulvovaginitis
  3. Saline preparation (Wet Prep)
    1. Pear-shaped motile organisms: Trichomonas Vaginitis
    2. Clue Cells: Bacterial Vaginosis
    3. Numerous Leukocytes
      1. Trichomonas Vaginitis
      2. Gonorrhea
      3. Chlamydia
    4. Desquamative Vaginitis (local irritant induced)
      1. Many White Blood Cells
      2. Parabasilar cells

X. Labs: Newer advanced screening (expensive)

  1. BD Affirm VPIII
    1. High Sensitivity for Bacterial Vaginosis, Trichomoniasis, and Vulvovaginal Candidiasis
    2. Some false positives with Trichomoniasis
    3. Requires 45 minutes to run
  2. PCR Testing
    1. Can differentiate Bacterial Vaginosis, Trichomoniasis, and Vulvovaginal Candidiasis

XI. Management

  1. Treat specific cause
    1. Bacterial Vaginosis
    2. Candida Vulvovaginitis
    3. Trichomonas Vaginitis
  2. Consider empiric treatment
    1. Not recommended due to poor correlation with symptoms
      1. Schaaf (1990) Arch Intern Med 150:1929-33 [PubMed]
    2. Anti-yeast medication (See Candida Vulvovaginitis)
    3. Metronidazole
    4. Clindamycin cream per vagina for 7 nights
  3. Consider increasing vaginal acidity (lower Vaginal pH)
    1. May increase Lactobacillus survival
    2. Aci-Jel Vaginal jelly per vagina for 21 days at hs
    3. Vinegar douche
      1. White Vinegar (2-4 tablespoons) in 1 quart water

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Ontology: Vaginitis (C0042267)

Definition (NCI) A non-infectious or infectious inflammatory process affecting the vagina.
Definition (NCI_CTCAE) A disorder characterized by inflammation involving the vagina. Symptoms may include redness, edema, marked discomfort and an increase in vaginal discharge.
Definition (CSP) inflammation of the vagina characterized by pain and a purulent discharge.
Definition (MSH) Inflammation of the vagina characterized by pain and a purulent discharge.
Concepts Finding (T033)
MSH D014627
SnomedCT 198213001, 266655004, 393596009, 155981006, 30800001
English Vaginitides, VAGINITIS, Vaginitis unspecified, Vaginitis, vaginitis (diagnosis), vaginitis, Vaginal Inflammation, Vaginitis [Disease/Finding], vagina inflammation, vaginal inflammation, inflammation of vagina, inflammation vaginal, Inflammation;vagina, inflammation vagina, Vaginitis unspecified (disorder), Vaginitis - non sp., Vaginal inflammation, Inflammation of vagina, Vaginitis (disorder), colpitis, inflammation; vagina, irritation; vagina, vagina; inflammation, vagina; irritation, Vaginitis, NOS, Colpitis, Vaginitis NOS, inflammation of the vagina
French VAGINITE, Inflammation vaginale, Vaginite
Portuguese VAGINITE, Inflamação da vagina, Colpite, Vaginite
Spanish VAGINITIS, Inflamación vaginal, Colpitis, vaginitis, no especificada, vaginitis, no especificada (trastorno), vaginitis (trastorno), vaginitis, Vaginitis
German VAGINITIS, Kolpitis, Vaginitis, Entzuendung der Vagina
Dutch vaginale ontsteking, vaginitis, colpitis, irritatie; vagina, ontsteking; vagina, vagina; irritatie, vagina; ontsteking, Vaginitis
Italian Infiammazione della vagina, Colpite, Vaginite
Japanese 腟の炎症, 腟炎, チツノエンショウ, チツエン
Swedish Slidkatarr
Czech vaginitida, kolpitida, pochva - zánět, Zánět pochvy, Kolpitida, Vaginitida, zánět poševní sliznice, zánět pochvy
Finnish Emätintulehdus
Russian VAGINIT, ВАГИНИТ
Croatian Not Translated[Vaginitis]
Polish Zapalenie pochwy
Hungarian Hüvelyi gyulladás, Colpitis, vaginitis
Norwegian Kolpitt, Vaginitt, Skjedekatarr

Ontology: Vaginal Discharge (C0227791)

Definition (NCI_CTCAE) A disorder characterized by vaginal secretions. Mucus produced by the cervical glands is discharged from the vagina naturally, especially during the childbearing years.
Definition (NCI) Normal or abnormal secretions from the vagina. Mucus produced by the cervical glands is discharged from the vagina naturally, especially during the childbearing years. Causes of abnormal vaginal discharge include infectious agents (e.g., Neisseria gonorrhea, Chlamydia trachomatis, Trichomonas, and Candida albicans), the presence of foreign bodies, and cervical or vaginal cancer.
Definition (MSH) A common gynecologic disorder characterized by an abnormal, nonbloody discharge from the genital tract.
Concepts Finding (T033)
MSH D019522
SnomedCT 139439007, 162159008, 198369007, 271939006, 70856007
English VAGINA DISCHARGE, Discharge, Vaginal, Discharges, Vaginal, Vaginal Discharges, vaginal discharge (diagnosis), vaginal discharge, vaginal discharge (physical finding), Vaginal Discharge, Discharge vaginal, Vaginal Discharge [Disease/Finding], Discharge;vaginal, fluor vaginalis, vagina discharge, vaginal discharge nos, vaginal discharges, Vaginal discharge NOS (finding), VAGINAL DISCHARGE, DISCHARGE, VAGINAL, Fluor vaginalis, Vaginal discharge, Vaginal discharge (finding), discharge; vagina, vagina; discharge, Vaginal discharge NOS, Vaginal discharge NOS (context-dependent category)
German VAGINALER AUSFLUSS, Ausfluss vaginal, Vaginaler Ausfluss, Scheidenausfluss, Fluor (vaginal), Scheidenfluss, Fluor vaginalis, Ausfluss (vaginal), vaginaler Ausfluss
Dutch fluor vaginalis, afscheiding; vagina, vagina; afscheiding, vaginale afscheiding, Vaginale afscheiding, Afscheiding, vaginale
French Sécrétions vaginales, PERTES VAGINALES, Écoulement vaginal, Écoulements vaginaux, Ecoulements vaginaux, Pertes vaginales, Perte vaginale
Italian Secrezione della vagina, Secrezione vaginale
Portuguese Flúor vaginal, PERDAS VAGINAIS, Corrimento vaginal, Descarga Vaginal
Spanish Flujo vaginal, secreción vaginal, SAI (categoría dependiente del contexto), VAGINAL, SUPURACION, secreción vaginal, SAI (hallazgo), secreción vaginal, SAI, Vaginal discharge NOS, flujo vaginal (hallazgo), flujo vaginal, secreción vaginal (hallazgo), secreción vaginal, Secreción vaginal, Excreción Vaginal
Japanese 腟分泌物, 腟帯下, チツタイゲ, チツブンピブツ, チツブンピツブツ
Swedish Vaginalflytning
Czech vaginální výtok, Výtok z pochvy, Poševní výtok, Vaginální fluor, výtok z pochvy, poševní výtok
Finnish Emätinerite
Russian VAGINAL'NYE VYDELENIIA, VLAGALISHCHNYE VYDELENIIA, ВАГИНАЛЬНЫЕ ВЫДЕЛЕНИЯ, ВЛАГАЛИЩНЫЕ ВЫДЕЛЕНИЯ
Polish Wydzieliny pochwowe
Hungarian hüvelyi váladékozás, Hüvelyi váladékozás, Fluor vaginalis
Norwegian Fluor vaginalis, Utflod, Vaginal utflod