Last reviewed: July 2020
Last updated: October  2019



History and exam

Key diagnostic factors

  • presence of risk factors
  • vaginal discharge
  • dysuria
  • discharge adherent to vaginal mucosa

Other diagnostic factors

  • prior episodes
  • pruritus
  • vulvodynia
  • vaginal dryness
  • dyspareunia
  • erythema
  • pale epithelium
  • shiny epithelium
  • decreased elasticity
  • friable epithelium
  • fever
  • vaginal bleeding
  • abdominal pain
  • strawberry cervix

Risk factors

  • douching
  • poor or excessive hygiene
  • antibiotic use
  • change in feminine hygiene products and/or soap
  • HIV infection
  • diabetes
  • black women
  • intrauterine device
  • oral contraceptive pill use
  • latex condom/diaphragm
  • reproductive age
  • menopause
  • multiple or new sex partners
  • tobacco
  • increased frequency of intercourse
  • pregnancy

Diagnostic investigations

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
More 1st investigations to order

Investigations to consider

  • culture of vaginal secretions
  • polymerase chain reaction (PCR) for trichomoniasis on vaginal secretions
  • rapid enzyme tests of vaginal secretions
More investigations to consider

Treatment algorithm


Diego S. Illanes

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.

Peer reviewersVIEW ALL


Department of Obstetrics and Gynecology

Virginia Commonwealth University




DC declares that he has no competing interests.


Minimally Invasive Gynecologic Surgery

Cedars-Sinai Medical Center

Los Angeles



JS declares that he has no competing interests.

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