gynecology and obstetrics
Overview of Vaginitis
Diagnosis of Vaginitis
History and pelvic examination Vaginal pH and saline and potassium hydroxide (KOH) wet mounts Sometimes nucleic acid amplification testing (NAAT) or other molecular diagnostic tests or culture Vaginitis is diagnosed using clinical criteria and in-office or laboratory testing. A pelvic examination is performed using a water-lubricated speculum (gel lubricants can be bacteriostatic), and vaginal secretions are obtained with a swab. A sample of vaginal discharge is tested with pH paper; pH is measured in 0.2 intervals from 4.0 to 6.0 (normal vaginal pH is 3.8 to 4.2). Then, secretions are placed on 2 slides: Saline wet mount prepared with 0.9%sodium chloride Potassium hydroxide (KOH) wet mount prepared with 10% potassium hydroxide The saline wet mount is examined microscopically as soon as possible to detect trichomonads, which can become immotile and more difficult to recognize within minutes after slide preparation. The slide is also examined for clue cells and polymorphonuclear leukocytes. The KOH wet mount is checked for a fishy odor (whiff test), which results from amines produced in trichomonal vaginitis or bacterial vaginosis. Potassium hydroxide is also used to test forCandida; KOH dissolves most cellular material except for yeast hyphae, making identification easier. . Also, some molecular diagnostic tests are commercially available for clinical use ( Diagnosis references ). Nucleic acid amplification testing (NAAT) is the preferred method to diagnose trichomonal vaginitis, but microscopy may be used. Culture is used when NAAT and microscopy are not available. If women have bacterial vaginosis or trichomonal vaginitis (and thus are at increased risk of sexually transmitted infections), cervical tests forNeisseria gonorrhoeaeandChlamydia trachomatis, common causes of sexually transmitted pelvic inflammatory disease (PID), are done. If contact irritant or allergic vulvitis is suspected, the patient should systematically eliminate potential irritants or allergens to identify the cause. Severe dermatitis or allergic reactions require evaluation by an allergist or dermatologist. Other causes of discharge should be ruled out, including A foreign body: If children have vaginal discharge, a vaginal foreign body may be present. Cervicitis : Cervical discharge due to cervicitis can resemble that of vaginitis. Pelvic Inflammatory Disease (PID) : An upper genital tract infection may also cause cervical discharge. Abdominal pain, cervical motion tenderness, or cervical inflammation suggests PID. Introduction to Gynecologic Tumors : Discharge that is watery, bloody, or both may result from vulvar, vaginal, or cervical cancer; cancers can be differentiated from vaginitis by examination, Papanicolaou (Pap) tests, and biopsy. Skin disorders: Vaginal pruritus and/or discharge may result from vulvar dermatoses (eg, Lichen Planus , In children, pelvic examination must be done by an experienced clinician. Speculum examination, if required, is usually done under anesthesia. If children have trichomonal vaginitis, evaluation for sexual abuse is required. Abuse should also be considered if they have unexplained vaginal discharge, which may be due to a sexually transmitted infection. 1.Cartwright CP, Lembke BD, Ramachandran K, et al: Development and validation of a semiquantitative, multitarget PCR assay for diagnosis of bacterial vaginosis.J Clin Microbiol50 (7):2321–2329, 2012. doi: 10.1128/JCM.00506-12 2.Schwebke JR, Gaydos CA, Nyirjesy P, et al: Diagnostic performance of a molecular test versus clinician assessment of vaginitis.J Clin Microbiol56 (6):e00252-18, 2018. doi: 10.1128/JCM.00252-18 3.Gaydos CA, Beqaj S, Schwebke JR, et al: Clinical validation of a test for the diagnosis of vaginitis.Obstet Gynecol130 (1):181–189, 2017. doi: 10.1097/AOG.0000000000002090 4.Schwebke J, Merriweather A, Massingale S, et al: Screening forTrichomonas vaginalisin a large high-risk population: Prevalence among men and women determined by nucleic acid amplification testing.Sex Transm Dis45 (5):e23-e24, 2018. doi: 10.1097/OLQ.0000000000000757 5.Coleman JS, Gaydos CA: Molecular diagnosis of bacterial vaginosis: An update.J Clin Microbiol56 (9):e00342–e00318, 2018. doi: 10.1128/JCM.00342-18 