Vaginitis

1. Inflammation of a sheath.
2. Inflammation of the vagina.

ETIOLOGY
Inflammation of the vagina may be caused by overgrowth or invasion of organisms such as gonococci, Chlamydiae, Gardnerella vaginalis, staphylococci, streptococci, spirochetes; viruses such as herpes; irritation from chemicals in douching, hygiene sprays, detergents, menstrual products, or toilet tissue; fungal infection (candidiasis) caused by overgrowth of Candida albicans or, less commonly, other candidal species; protozoal infection, e.g., Trichomonas vaginalis; neoplasms of the cervix or vagina; poor hygiene; irritation from foreign bodies, e.g., a pessary or a retained tampon; or vulvar atrophy. Other, rare, causes are parasitic illnesses, or, in malnourished women, pellagra.

SYMPTOMS
The patient experiences vaginal discharge, sometimes malodorous and occasionally stained with blood; irritation, burning, or itching; increased urinary frequency; and pain during urination or examination. On examination, the vaginal mucous membrane is reddened, and there may be superficial maceration or ulceration.

TREATMENT
Specific therapy is given as indicated for the underlying cause. Improved perineal hygiene is emphasized by instructing in the proper method of cleaning the anus after a bowel movement, the proper use of menstrual protection materials, and the necessity of drying the vulva following urination.

PREVENTION
In addition to being taught improved perineal hygiene, patients should be encouraged to wear all-cotton underpants or panties with a cotton crotch area, not to wear underwear to bed, and to avoid tight-fitting pants or panty hose that promote moisture and growth of organisms .

PATIENT CARE
During examination of the patient, aseptic techniques are used to collect specimens. The health care provider supports the patient throughout the procedures, explaining each procedure and warning the patient of possible discomfort. The patient should be advised that persistent or recurrent candidiasis indicates a need for assessment for pregnancy or diabetes mellitus. If vaginitis is due to a sexually transmitted disease, the sexual partner should receive treatment with the patient to prevent reinfection. Certain sexually transmitted vaginal infections must be reported to local or state public health officials with the patient's known sexual contacts.




Vaginitis adhaesiva
Inflammation of the vagina causing adhesions between its walls.

Atrophic vaginitis
Postmenopausal thinning and dryness of the vaginal epithelium related to decreased estrogen levels.
SYN: SEE: postmenopausal vaginitis; SEE: senile vaginitis; SEE: urogenital atrophy
Symptoms include burning and pain during intercourse. Estrogen replacement therapy, hormone replacement therapy, or application of topical estrogen restores the integrity of the vaginal epithelium and supporting tissues and relieves symptoms.

Candidal vaginitis
A yeast infection caused by Candida albicans.
Symptoms include a thick, curdlike adherent discharge; itching; dysuria; and dyspareunia. The vulva and vagina are bright red. History usually reveals one or more risk factors: use of oral contraceptives or broad-spectrum antibiotics; immune defects; diabetes mellitus; pregnancy; or frequent douching. Diagnosis is established by the presence of hyphe and buds on a wet smear treated with 10% potassium solution, a pH of 4.5 or less, and/or of growth of culture on Nickerson's or Sabouraud's media. Treatment includes topical or oral antifungal agents, or both. Oral fluconazole, given once, or topical applications of miconazole, clotrimazole, butoconazole, or terconazole, given 3 to 7 days, promptly relieve symptoms. Recurrence of symptoms after treatment is often due to presence of candida species other than C. albicans, presence of a mixed infection, or reinfection. Either use of a different agent or a longer course of treatment (14 to 21 days) is indicated, as well as testing for hyperglycemia.
SYN: SEE: moniliasis

Chlamydial vaginitis
The most common sexually transmitted vaginal infection in the U.S., caused by an obligate intracellular parasite, Chlamydia trachomatis. Chlamydial infection is also a major cause of pelvic inflammatory disease, tubal occlusion, infertility, ectopic pregnancy, nongonococcal urethritis, and ophthalmia neonatorum. Asymptomatic chlamydial infection has been implicated in the development of preterm labor and birth in high-risk women. Patients may be asymptomatic or have a thin or purulent vaginal discharge, dysuria, and/or lower abdominal pain. Diagnosis is established by testing for specific monoclonal antibodies. Doxycycline is the drug of choice, except during pregnancy (it damages fetal bone and tooth formation). During pregnancy the infection is treated with erythromycin or azithromycin.
SEE: Chlamydia

Diphtheritic vaginitis
Vaginitis with membranous exudate caused by infection with Corynebacterium diphtheriae.

Emphysematous vaginitis
A rare, benign vaginitis with gas-bubble formation in the vaginal wall.

Gardnerella vaginalis vaginitis
SEE: Bacterial vaginosis.

Granular vaginitis
Vaginitis with cellular infiltration and enlargement of papillae.

Nonspecific vaginitis
A rare vaginitis in which no particular factor or etiological agent is identifiable; a contact-related allergic response may be involved. The inflammation usually resolves spontaneously. Treatments include topical creams and ointments.
SEE: bacterial vaginosis

DIAGNOSIS
The diagnosis is established when clinical symptoms of vaginitis are present, but no organisms are found in laboratory specimens.

Postmenopausal vaginitis
SEE: Atrophic vaginitis.

Senile vaginitis
SEE: Atrophic vaginitis.

Vaginitis testis
Inflammation of the tunica vaginalis of the testis.

Trichomonas vaginalis vaginitis
Vaginitis caused by flagellate protozoa that infect the vagina, urethra, and Skene's ducts. Although the individual inflammatory response can include severe vulvar irritation and burning, dysuria, dyspareunia, and profuse, thin, frothy, yellow-green to gray discharge, nearly 50% of infected women are asymptomatic. Sixty percent of the sexual partners of infected women share the infection. On inspection, the vulva may appear reddened and edematous. About 10% of infected women exhibit characteristic “strawberry patches” in the upper vagina and upper cervix. Diagnosis is based on seeing the highly motile organism with three to five flagella in a saline wet smear. Oral metronidazole is the organism-specific treatment.