Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (266 page)

   Other tests: HIV and syphilis testing should be requested. Additional testing and microbiologic testing are performed on the basis of signs and symptoms in specific patients.

Suggested Reading

Peipert JF, Boardman L, Hogan JW, et al. Laboratory evaluation of acute upper genital tract infection.
Obstet Gynecol.
1996;87:730–736.

VAGINOSIS AND VAGINITIS (BACTERIAL VAGINOSIS, TRICHOMONIASIS, VULVOVAGINAL CANDIDIASIS)
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Definition

   Vaginitis is used to describe conditions associated with significant inflammation, whereas vaginosis is used when vaginal secretions do not show a marked increase in inflammatory cells. Symptoms attributed to vaginitis may also be due to primary cervicitis, urethritis, or inflammation to other related tissues.

   Changes in the amount or character of vaginal discharge are common presenting complaints of women seeking medical attention. Although there is normal variability in vaginal secretions, infectious and other pathologic causes are common and should be carefully evaluated.

   Causes

   Complaints associated with noninfectious causes may be indistinguishable from those caused by genital tract infections. Common noninfectious causes include the following: lead to vaginal dryness and itching rather than an increase in vaginal secretions. Here, there are mixed nonspecific gram-negative rods with decreased lactobacilli; vaginal cytology shows an atrophic pattern.

   Allergy and irritants. Many products, such as detergents, soaps, bubble bath, latex (e.g., condoms), and topical medications, may cause inflammation of the vaginal mucosa and changes in the character and volume of secretions. Clinical management requires elimination of the allergen or irritant.

   Atrophic vaginitis. This type of vaginitis is caused by estrogen deficiency and is usually associated with menopause but may be seen in the postpartum period or as a result of medication. Symptoms of estrogen deficiency

   Physiologic leukorrhea. Vaginal secretions may vary significantly in normal women, especially related to the menstrual cycle. The volume of vaginal secretion is typically greatest in mid-cycle. Significant symptoms and inflammation are not seen with physiologic leukorrhea; the odor, color, and viscosity of secretions are similar to the characteristics in the absence of leukorrhea.

   Bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis are the most common causes of clinically significant vaginosis/vaginitis and are described in detail below. Other infectious causes of vaginitis include the following:

   Condyloma acuminata. Increased vaginal discharge, pruritus, and pain are common symptoms caused by anogenital warts.

   Foreign body or traumatic vaginitis. Foreign bodies, like a retained tampon, may cause a change in the normal vaginal flora and mild signs and symptoms of infection. Removal of the foreign body is usually all that is required for clinical management.