Vulvovaginitis

*Normal pH=3.5-4.7 in reproductive aged women. Higher pH

before puberty and after menopause. Most common cause of Swab for all of these in the vaginal canal behind the cervix, also check pH.
infectious vaginal discharge Look at saline slide first due to Trich motility for ~5 minutes

Symptoms
Overgrowth of facultative anaerobes
(normal flora). Abnormal gray/white
discharge. Anaerobes replace the
Bacterial Vaginosis/
normal lactobacilli of the vagina. NO
Gardnerella
erythema or inflammation (only one
in this group of three that doesn’t).
NOT an STD, not really any sx
Lives in vagina, male/female
urethra, swimming pools/hot tubs.
Severe vulvar itching or burning
Trichomoniasis (inflammatory reaction), frothy,
(protozoa) yellow-green to gray discharge,
strawberry cervix. May have fishy
smell. Can cause PID, endometritis,
PROM, PTD, low birth weight
Itching (inflammation), burning,
external dysuria, dyspareunia with Normal
bright red vulva, thick odorless (pH 3.5-
Candidiasis (yeast)
"cottage cheese" discharge. NOT an
STD. More common in diabetics and odorless
the immunosuppressed
Epithelium diminished by decreased
estrogen. Loss of estrogen, loss of
glycogen and loss of lactic acid.
Atrophic Vaginitis Dryness, itching, burning or
dyspareunia. May have urinary
atrophy as well-urgency, frequency,
recurrent UTI, incontinence
pH
Visualization/Diagnosis
change
Positive whiff test (fishy odor),
clue cells (epithelials with
pH>4.5 ,
numerous coccoid bacteria,
fishy
cytoplasm resembles ground
glass, on saline slide).
Flagellate protozoan (mobile
and pear shaped!). See
epithelial cells in vaginal
pH>4.5 ,
secretions (saline slide)
may be
suspended in normal saline.
fishy odor
Hardy organism, can isolate
from wet surface up to 6 hours
after inoculation
Pseudohyphae on saline or
4.7), 10% KOH, culture
pH>4.7
Treatment Risk Factors
Metronidazole (topical, safe in
pregnancy). Avoid alcohol during
use of metronidazole and 48
hours after last dose! (Disulfiram
rxn=N/V, facial flushing, HA,
hypotension, tachycardia,
dizziness). SE of
metronidazole=nausea,
abdominal discomfort, bloating,
diarrhea
Metronidazole (oral, safe in
pregnancy, do not drink alcohol
while on it), avoid unprotected
intercourse. Treat partners
Pregnant, diabetic,
Oral Fluconazole 150 mg (or any
immunosuppressed, broad
other azole)
spectrum antibiotic therapy
Vaginal estrogen therapy