Vaginitis

1. Vaginitis
by
Maureen Foster, CNM

2. Definition:
Disorder of the vagina caused by infection,
inflammation, or changes in the normal
vaginal flora. Symptoms include vaginal
discharge, odor, pruritus, and/or
discomfort.

3. Causes:
Most common causes of vaginaits are:
1. Bacterial vaginosis
2. Candida vulvovaginitis
3. Trich
These disorders account for more than
90% of vaginitis cases.

4. Bacterial Vaginosis:
*Most common cause of vaginal discharge
- 40-50% of cases
*Prevalence of BV 29% in general
population of women aged 14-49 yrs of
age and 50% prevalence in African
American women.

6. Diagnosis:
*3 of the 4 criteria listed below are
necessary to make the diagnosis of BV
*homogeneous, thin, graysish/white
discharge that smoothly coats the vaginal
walls.
*ph>4.5
*positive whiff test (+ fishy odor - gross!)
when 10% KOH is added to the slide.
*clue cells on saline wet mount

7. Presence of clue cells is the single most
reliable predictor of BV.
At least 20% of the epithelial cells should
be clue cells.

8. Symptoms:
*approximately 50-75% of women with BV
are asymptomatic
• most common complaint is an
unpleasant "fishy" smelling discharge.
* burning, itching, dyspareunia, dysuria

9. Treatment: Non-Pregnant Women:
• Flagyl 500 mg po bid X 7 days
• Metrogel 0.75% 5 grams intra vaginally
once daily X 5 nights
* Clindamycin 2% cream for 7 days
(recurrent)

10. Treatment in Pregnancy:
* Flagyl (metronidazole) 500 mg bid X 7
days
* Flagyl 250 mg tid X 7 days
* Clindamycin 300 mg bid X 7 days

11. Candida Vulvovaginitis:
* Candida Vulvovaginitis accounts for
approx. 1/3 of vaginitis cases.
* Candida species are part of the lower
genital tract flora in 20-50% of healthy
asymptomatic women.
* Candida albicans is responsible for 80-
92% of episodes of vulvovaginal
candidiasis.
* Candida organisms access the vagina via
migration across the perianal area from the
rectum.

12. Risk Factors:
* Diabetes - Type 2 more prone to non-
albicans species
* Use of antibiotics: 1/4-1/3 of women
taking broad spectrum antibiotics will inhibit
normal bacterial flora which then allows
growth of potential pathogens such as
candida.
* Increase estrogen levels - ie, oral
contraception use, pregnancy or estrogen
therapy.
* Immunosuppression
* Contraceptive devices

13. Clinical Features:
* Vulvar pruritis is the most common
complaint
* Dysuria (typically externally)
* Irritation, soreness and dyspareunia
* Vaginal discharge can be typically
white/clumpy (curd like)

14. Diagnosis:
* Vag pH is 4-4.5, which distinguishes it
from BV (4.5) or trich.
* Confirmed by finding the organism on wet
mount from the vaginal discharge

16. Treatment:
• treatment indicated for relief of
symptoms
• oral meds take a day or two longer to
relieve symptoms
• topical treatments may cause burning
when applied
• Diflucan (fluconazole) 150 mg 2-3
sequential doses 72 hrs apart.
• For severe cases (vulvar inflammation)
some clinicians suggest use of low
potency corticosteroids for 48 hrs until
the anti-fungal med exerts its effect.

17. Trichomonas
* The responsible organism is the
flagellated protozoan trichomonas
vaginalis.
* Found in the vagina, urethra, and
paraurethral glands of infected women.
* Trich is virtually always sexually
transmitted.

19. Symptoms:
* Purulent, malodorous, thin vaginal
discharge (70% of cases) burning, pruritus,
dysuria, increased frequency, and
dyspareunia. Post-coital bleeding can
occur.
* Exam reveals erythema of the vulva and
vaginal mucosa.
* Classic green-yellow frothy discharge is
seen in 10-30% of affected women.

20. Diagnosis:
* Presence of motile trichamonads on wet
mount is diagnostic of infection in 50-70%
* Organism remain motile for 10-20 min
after collection.
* Vaginal culture in pt with suggestive
clinical findings or when microscopy is
unavailable.

21. Treatment:
* Both partners must be treated!!
* 2 grams of either tinidazole or
metronidazole (single dose better
compliance).
* Metronidazole 500 mg bid X 7 days

22. Thank you so much!