Nontrichomonal purulent vaginitis: Clinical approach

Abstract

Although trichomonal vaginitis and cervicitis are responsible for most presentations of a frankly purulent vaginal discharge, nontrichomonal vaginitis and purulent exudate are being seen in an increasing number of cases. Purulent vaginitis remains poorly defined and largely ignored, with little increase in the amount of knowledge we have of this not infrequent entity. Accordingly, a variety of empirical therapies, often including multiple simultaneous measures, are prescribed. Considerable numbers of causes are now identified, and this review describes a step-by-step approach to diagnosis and management.

Elevated Cervical White Blood Cell Infiltrate Is Associated with Genital HIV Detection in a Longitudinal Cohort of Antiretroviral Therapy–Adherent Women

“…Cervical cell types were enumerated by microscopic examination using Endtz-trypan stain to differentiate epithelial cells, polymorphonuclear cells (PMNs), and mononuclear cells; to compute the total white blood cell (WBC) count; and to evaluate red blood cell (RBC) counts [39]. Cervical cells were enumerated from a suspension of cells eluted from the cytobrush, and у100 cells were counted, increasing the sensitivity of cell-type characterization, compared with 130 PMNs per high-powered field measures [8,40,41], similar to methods described by others [33]. Total WBC counts were enumerated in the vaginal mucosa by means of Gram-stained vaginal smears.…”

Postmenopausal vaginitis

“…In this author's experience, cultures for T. vaginalis and Group A streptococcus are important to rule out as the cause of the infection. As noted by Sobel [26] in his review, vaginal 2% clindamycin is extremely valuable. Most experts will add exogenous estrogen after treating DIV in an effort to decrease the estimated 30% chance of recurrence.…”

New Perspectives on the Normal Vagina and Noninfectious Causes of Discharge

“…27 Variants of normal include small-moderate amount of white vaginal discharge and depending on the woman's age, a more or less visible cervical ectropion. Cervical ectropion occurs with eversion of the endocervix, exposing columnar epithelial cells to the vaginal environment and is commonly encountered in adolescents, pregnant women or those taking estrogen-containing contraceptives.…”

“…Mucopurulent cervicitis (MPC) is defined by the presence of 30 or greater polymorphonuclear cells per high-power field. 27 Generally, the diagnosis of cervicitis will be clinical, with mucopus coming from the cervix, perhaps with associated contact bleeding of the cervix.…”

“…It is unclear whether there is a benefit to treating the condition. 29 Vaginal inflammation may present as erythema, rawness, ulcerations, petechiae, hemorrhage, or rashes in the vault, 27 whereas cervicitis may be distinguished by friable appearance, hemorrhage, edema, purulent discharge present at endocervix. One especially important triage tool is to check the vaginal pH.…”