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*In patients with normal pH, with hyphae demonstrated on microscopy, culture is not neccessary and treatment can be initiated | *In patients with normal pH, with hyphae demonstrated on microscopy, culture is not neccessary and treatment can be initiated | ||
*In patients with normal pH and negative microscopy, culture for candida must be done | *In patients with normal pH and negative microscopy, culture for candida must be done | ||
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| [[Bacterial Vaginosis]] ||>4.5|| Clue cells are demonstrated|| | | [[Bacterial Vaginosis]] ||>4.5|| Clue cells are demonstrated|| | ||
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*Milky homogenous, adherent vaginal discharge | *Milky homogenous, adherent vaginal discharge | ||
*Positive “whiff” test, which is an amine or “fishy” odor noted after the addition of 10% potassium hydroxide | *Positive “whiff” test, which is an amine or “fishy” odor noted after the addition of 10% potassium hydroxide | ||
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| [[Trichomoniasis]] ||Normal||Motile Trichomonads|| Nucleic acid amplification test(NAAT) | | [[Trichomoniasis]] ||Normal||Motile Trichomonads|| Nucleic acid amplification test(NAAT) | ||
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* | * | ||
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| [[Atrophic Vaginitis]] ||Normal|| Vaginal smear cytology shows increased parabasal cells|| | | [[Atrophic Vaginitis]] ||Normal|| Vaginal smear cytology shows increased parabasal cells|| | ||
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* | * | ||
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Revision as of 21:38, 13 January 2017
Vaginitis
Overview
Vulvovaginitis is a common condition for which women seek medical care accounting for approximately 10 million office visits every year. It is defined as symptoms that cause itching, irritation, burning and abnormal vaginal discharge. The three common causes of vaginal discharge in reproductive age group include: most common being Bacterial Vaginosis followed by Candida vulvovaginitis and Trichomoniasis.
Synopsis
Diagnosis
Candida Vulvovaginitis | Bacterial Vaginosis | Trichomoniasis | Atrophic Vaginitis | |
---|---|---|---|---|
Vaginal pH | Normal | Increased | Normal | |
Wet mount Microscopy | Hyphae and pseudohyphae
can be demonstrated |
Clue cells | Motile trichomonads | |
10% KOH smear | Hyphae and pseudohyphae
can be demonstrated |
|||
Gold Standard diagnostic test | Culture | Vaginal maturation
Index |
Treatment
Candida Vulvovaginitis | Bacterial Vaginosis | Trichomoniasis | Atrophic Vaginitis | |
---|---|---|---|---|
Medical Therapy | ||||
Recurrence | ||||
HIV positive individuals | ||||
Treatment for partner | ||||
Pregnant women |
Symptoms
Disease | Symptoms | Examination Findings | |||||
---|---|---|---|---|---|---|---|
Discharge | Dysuria | Vaginal odor | Dyspareunia | Genital skin lesion | Genital pruritus | ||
Candida Vulvovaginitis | ✔ | ✔ | ✔ | ✔ | ✔ | ✔✔ |
|
Bacterial Vaginosis | ✔ | ✔ |
| ||||
Trichomoniasis | ✔ | ✔ | ✔ | ✔ | ✔ |
| |
Atrophic Vaginitis | ✔ | ✔ | ✔ | ✔✔ | ✔ | ✔ |
|
Diagnosis
Disease | Investigation | Diagnostic Approach | Treatment | ||
---|---|---|---|---|---|
pH | Saline Wet mount preparation | Gold Standard test | |||
Candida Vulvovaginitis | Normal | Hyphae and pseudohyphae can be demonstrated | Culture |
|
|
Bacterial Vaginosis | >4.5 | Clue cells are demonstrated |
Amsel’s criteria: Presence of three out of four criteria is required to make the diagnosis of BV
|
||
Trichomoniasis | Normal | Motile Trichomonads | Nucleic acid amplification test(NAAT) |
|
|
Atrophic Vaginitis | Normal | Vaginal smear cytology shows increased parabasal cells |
|