Pattern Recognition

Vaginitis

can present with a number of symptoms in addition to vaginal discharge, including pruritus, dysuria, irritation, soreness, and dyspareunia.

Clues in the

history that point to a specific diagnosis include:

• Candida vulvovaginitis, typically presents with scant discharge and marked inflammatory

  symptoms

Table-1

Causes of Vaginitis

Infectious vaginitis

Common causes

Bacterial vaginosis

Vulvovaginal candidiasis (20 to 50 per cent of cases)

Trichomoniasis (15 to 20 percent of cases)

Less common causes

Atrophic vaginitis with secondary bacterial infection

Foreign body with secondary infection

Desquamative inflammatory vaginitis (clindamycin-responsive)

Streptococcal vaginitis (Group A)

Ulcerative vaginitis associated with Staphylococcus aureus and toxic shock syndrome

Idiopathic vulvovaginal ulceration associated with human

Immunodeficiency virus infection

Noninfectiou vaginitis

Chemical or other irritant

Allergic, hypersensitivity, and contact dermatitis (lichen simplex)

Traumatic vaginitis

Atrophic vaginitis

Postpuerperal atrophic vaginitis

Desquamative inflammatory vaginitis (Steropid responsive)

Erosive lichen planus

Collagen vascular disease, Behoet's syndrome, pemphigus syndromes

Idiopathic vaginitis

• Bacterial vaginosis are asymptomatic or present with only vaginal discharge and no inflammatory complaints

• Dyspareunia is a common feature of atrophic vaginitis

• Abdominal pain is suggestive of cystitis or pelvic inflammatory disease

• Exposure to a new sexual partner is suggestive of sexually transmitted disease

• Timing of symptom onset:

• Trichomoniasis often occurs during or immediately after the menstrual period

• Candida vulvovaginitis often occurs during the premenstrual period

• Use of antibiotics and high-estrogen oral contraceptive pills may predispose to candida vulvovaginitis

• Increased physiologic discharge can occur with oral contraceptives

  However, none of these findings in the history allow a definitive diagnosis since there is considerable overlap among the different disorders. Thus, a physical examination and some diagnostic studies are necessary in all women.

  Physical examination

  The pelvic examination should focus upon the degree of vulvovaginal inflammation and characteristics of the vaginal discharge; the presence of cervical inflammation; and abdominal or cervical motion tenderness.

  The vulva is usually normal in bacterial vaginosis without erythema, edema, or fissure formation.