Last reviewed: 2 Nov 2022
Last updated: 24 Feb 2022
Summary
Definition
History and exam
Key diagnostic factors
- vaginal discharge
- dysuria
- discharge adherent to vaginal mucosa
More key diagnostic factors
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
Other diagnostic factors
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
More risk factors
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
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 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
Worcester
MA
Disclosures
DSI declares that he has no competing interests.
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.
Differentials
- Gonorrhea
- Chlamydia
- Cervicitis
More DifferentialsGuidelines
- Sexually transmitted infections treatment guidelines 2021
- European (IUSTI/WHO) guideline on the management of vaginal discharge
More GuidelinesPatient leaflets
Bacterial vaginosis
Menopause: should I take HRT?
More Patient leaflets
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