This document defines vaginitis as a disorder of the vagina caused by infection, inflammation, or changes in normal vaginal flora with common symptoms including discharge, odor, itching, and discomfort. The three most common causes are bacterial vaginosis, candida vulvovaginitis, and trichomonas, accounting for over 90% of cases. Bacterial vaginosis is the most prevalent cause, affecting about 40-50% of those with vaginitis. Candida vulvovaginitis and trichomonas each account for about 1/3 of cases. The document provides details on diagnosis and treatment for each of the three main causes of 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!