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Vaginitis

Last reviewed: 6 Oct 2024
Last updated: 04 Jun 2024

Summary

Definition

History and exam

Key diagnostic factors

  • vaginal discharge
  • dysuria
  • discharge adherent to vaginal mucosa
Full details

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
Full details

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
Full details

Diagnostic tests

1st tests 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 (VDRL) test
  • serum rapid plasma reagin (RPR) test
Full details

Tests to consider

  • culture of vaginal secretions
  • polymerase chain reaction (PCR) for trichomoniasis on vaginal secretions
  • rapid enzyme tests of vaginal secretions
Full details

Treatment algorithm

ACUTE

nonpregnant: isolated acute episode

pregnant: isolated acute episode

atrophic vaginitis

irritant or allergic vaginitis

ONGOING

nonpregnant: persistent or recurrent symptoms

pregnant: persistent or recurrent symptoms

Contributors

Authors

Diego Illanes, MD, FACOG, FACS
Diego Illanes

Medical Director

Urogynecology

Milford Regional

Milford

MA

Disclosures

DSI is an advisor for Coloplast, Medtronic and Vicarious.

Peer reviewers

David Chelmow, MD

Chair

Department of Obstetrics and Gynecology

Virginia Commonwealth University

Richmond

VA

Disclosures

DC declares that he has no competing interests.

Jonathon Solnik, MD

Director

Minimally Invasive Gynecologic Surgery

Cedars-Sinai Medical Center

Los Angeles

CA

Disclosures

JS declares that he has no competing interests.

  • Vaginitis images
  • Differentials

    • Gonorrhea
    • Chlamydia
    • Cervicitis
    More Differentials
  • Guidelines

    • UK national guideline on the management of Trichomonas vaginalis​
    • UK national guideline on the management of Trichomonas vaginalis
    More Guidelines
  • Patient information

    Bacterial vaginosis

    Menopause: should I take HRT?

    More Patient information
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