Vaginitis - Diagnosis
Clinical diagnosis is based on the symptoms and a pelvic examination
During the pelvic exam a speculum is introduced into the vagina for direct visualization of the cervix. The following features are noted:
- The amount, nature, color and odor of the discharge is noted.
- The vaginal mucosa is observed for any bleeding, atrophy and reddening,
- Yeast infection reveals thrush-like patches and scratch marks on the mucous membrane of the vagina
- In trichomoniasis a thin, greenish yellow, bubbly discharge is seen and the mucous membrane has a reddened strawberry-like appearance.
The discharge is collected and the following tests are done to aid in the diagnosis.
Saline wet - mount preparation
A wet preparation of the discharge is made on glass slide and observed under a microscope to make the following evaluations:
- Presence of budding yeasts or pseudo hyphae is suggestive of Yeast Infection.
- Presence of clue cells is suggestive of bacterial vaginosis
- Presence of trichomonads is suggestive of trichomoniasis.
Potassium hydroxide (KOH) preparation - The vaginal discharge is mixed with a solution of potassium hydroxide (KOH). The presence of yeast hyphae and spores indicate a yeast infection.
Vaginal pH - The normal vaginal pH is 3.8 to 4.5. pH more than 4.5 is suggestive of Bacterial Vaginosis (BV), trichomoniasis, or atrophic vaginitis.
Whiff test - The vaginal discharge is mixed with potassium hydroxide (KOH) solution and the odor observed. A b fishy odor is suggestive of Bacterial Vaginosis (BV).
