Vaginal Infections Update

Abstract

Vaginal symptoms are one of the leading reasons that women visit their health care providers. Women often self-diagnose and may treat themselves inappropriately. This article describes the etiology, risk factors, symptoms, diagnosis, and treatment of the 3 most common vaginal infections: bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis.

Importance of the physical exam and in-office tests in the evaluation of vulvovaginal irritation

“…Current literature supports this approach, strongly encouraging the clinician faced with vulvovaginal complaints to 'just take a look' before recommending medical management. 1,2,15,17,18 Evaluation of the patient with vulvovaginal irritation Problem-Focused History: A patient's self-reported signs and symptoms alone are not sufficient to correctly diagnose the cause(s) of vulvovaginal irritation, but they can contribute to the overall clinical picture. Vulvovaginal irritation may be characterized as itching, burning, or redness, and abnormal discharge may be described as thin, thick or cheesy (curd-like).…”

“…1,2 A vaginal yeast culture is helpful when pseudo-hyphae or spores are not seen on microscopy. 17,18 Vaginal Trichomoniasis: As with BV, patient reported signs and symptoms are not specific for trichomoniasis and the vaginal pH is typically >4.5 with both of these conditions. While an increase in the number of leukocytes relative to epithelial cells is typical, the finding of motile trichomonads is the only specific diagnostic finding on microscopy.…”

“…While an increase in the number of leukocytes relative to epithelial cells is typical, the finding of motile trichomonads is the only specific diagnostic finding on microscopy. 2,17,18 As the sensitivity of microscopy for diagnosing trichomoniasis varies from 50 to 80%, rapid antigen testing, a nucleic acid probe, or PCR can be used to aid in the diagnosis of this condition.…”

Clinical Evaluation of the Efficacy and Safety of a Medical Vaginal Device Containing Rigenase® for the Treatment of Vaginosis: A Randomized Study

“…The clinical status is supported by an alteration of the physiological vaginal flora, which can be due to a proliferation of common germs (vaginosis) or to the colonization by pathogenic microorganisms (specific vaginitis) [8]. The vaginosis is the most common form and is due to the replacement of Lactobacilli normally present in the vagina (Doderlein bacilli, mainly represented by L. crispatus, L. iners, L. gasseri and L. Jensenii) by anaerobic germs such as Gardenella vaginalis, mycoplasma, etc.…”

Comparison of Clinical and Cytological Findings in the Diagnosis of Vulvovaginitis in Adult Women

“…Inability to diagnose vulvovaginal infections is a growing concern. For various reasons, specialist knowledge of how to prepare and assess wet mount slides for microscopic investigation of vaginal discharge is the exception rather than the rule in outpatient clinics or hospitals [3][4][5]. In contrast to developed countries where regulations require wet mount proficiency testing, gynecologists in Brazil do not currently need to prove their specialist knowledge in this area.…”