Bacterial vaginosis continues to be a leading cause of vaginitis; other common infectious causes include trichomoniasis and candidiasis, although non-infectious causes are also possible.
Affects all age groups of women, particularly during their reproductive years.
Common symptoms include discharge, pruritus, and dyspareunia.
It is recommended to screen for sexually transmitted infections (STIs; also known as sexually transmitted diseases [STDs]) in all women with infective vaginitis.
Sexual partners of individuals with Trichomonas vaginalis should be treated and offered screening for other STIs.
Vaginitis is inflammation of the vagina due to changes in the composition of the vaginal micro-environment from infection, irritants, or from hormonal deficiency (e.g., atrophic vaginitis). Bacterial vaginosis, trichomoniasis, and candidiasis are types of infections that cause vaginitis.
History and exam
Key diagnostic factors
- presence of risk factors
- vaginal discharge
- discharge adherent to vaginal mucosa
Other diagnostic factors
- prior episodes
- vaginal dryness
- pale epithelium
- shiny epithelium
- decreased elasticity
- friable epithelium
- vaginal bleeding
- abdominal pain
- strawberry cervix
- poor or excessive hygiene
- antibiotic use
- change in feminine hygiene products and/or soap
- HIV infection
- black women
- intrauterine device
- oral contraceptive pill use
- latex condom/diaphragm
- reproductive age
- multiple or new sex partners
- increased frequency of intercourse
1st investigations to order
- vaginal pH
- amine 'whiff' test of vaginal secretions
- wet mount microscopy of vaginal secretions
- Gram stain of vaginal secretions
- HIV test
- nucleic acid amplification test (NAAT)
- venereal disease research laboratory (VDLR) test
- serum rapid plasma reagin (RPR) test
Investigations to consider
- culture of vaginal secretions
- polymerase chain reaction (PCR) for trichomoniasis on vaginal secretions
- rapid enzyme tests of vaginal secretions
non-pregnant: isolated acute episode
pregnant: isolated acute episode
irritant or allergic vaginitis
non-pregnant: persistent or recurrent symptoms
pregnant: persistent or recurrent symptoms
Diego S. Illanes, MD, FACOG, FACS
Female Pelvic Medicine and Reconstructive Surgery
Chairman of Obstetrics & Gynecology
Reliant Medical Group
Assistant Professor of Obstetrics and Gynecology
University of Massachusetts Medical School
DSI declares that he has no competing interests.
David Chelmow, MD
Department of Obstetrics and Gynecology
Virginia Commonwealth University
DC declares that he has no competing interests.
Jonathon Solnik, MD
Minimally Invasive Gynecologic Surgery
Cedars-Sinai Medical Center
JS declares that he has no competing interests.
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