Defined as an infection or inflammation of the vulvovagina.
Causes genital discomfort, reduced sexual pleasure and psychological distress.
Most common cause of infectious vulvovaginitis is candidiasis which accounts for 40-50% of cases.
More than 70% of cases of vaginitis are attributed to candidiasis, bacterial vaginosis, or trichomoniasis.
Noninfectious causes include hypersensitivity, collagen vascular and inflammatory processes.
Bacterial vaginosis may correct without treatment.
Most cases of infectious candidiasis caused by Candida albicans.
5-8% of patients have chronic, recurrent vulvovaginitis secondary to Candida.
Patients presents with symptoms that include: abnormal discharge, malodor, vulvovaginal pruritus, irritation, and dyspareunia.
Some patients present with purées without vaginal discharge.
Some patients present with puréed is without vaginal discharge.
The medical history and symptom presentation are both insufficient for accurate diagnosis, and it is recommended that diagnostic testing be performed.
Clinical evaluation impatiens with symptoms of vaginitis include medical history, physical examination, collection of specimens for vaginal pH and microscopy.
Criteria for diagnosis is established when three of the four criteria which include abnormal discharge, 20% of clue cells on microscopy, a positive whiff test with amine odor following application of 10% potassium hydroxide, and an elevated vaginal pH of 5.0 or greater.
Preparation and evaluation of 10% potassium hydroxide and 0.9% saline wet mounts provide strategies for diagnosis.
Bacterial cultures are not needed in the evaluation bacterial vaginosis.
Majority of women with recurrent infection have no known risk factors.
Risk factors for candida vulvovaginitis include diabetes, antibiotic use, and glucocorticoid use.
Vaginal pH and wet mount evaluation are preferred for diagnosis with immediate and accurate results.
PCR is available and has comparable sensitivity and specificity to culture.
For patients with recurrent vulvovaginitis due to candida or negative microscopic findings, fungal culture provides information including sensitivity studies.
Not considered a sexually transmitted disease and affects immunocompetent women of all economic strata.
Testing and treatment of sexual partners is not indicated.
Uncomplicated candida vulvovaginitis is treated effectively by topical vaginal antifungal formulations or a single dose of oral fluconazole with curates of 80 to 90%.
Oral fluconazole is more expensive than the vaginal formulation.
Topical therapy is effective, although on minority patients report local irritation.
Oral therapy uncommonly causes nausea headache and may interact with statin therapy.
Weekly fluconazole for six months reduces the frequency of recurrent candida vulvovaginitis by more than 90%.
Despite long-term fluconazole cure of recurrent symptomatic disease is difficult to achieve.
Bacterial vaginosis represents a disruption of the vaginal microbiome.
Bacterial vaginitis is associated with sexual activity, lack of condom use, sex with a female partners, and douching in reproductive age persons.
First line therapy includes all the topical metronidazole or topical clindamycin which demonstrate cure rates of 75 to 86%.
Currently no evidence exists to recommend probiotics.
Condoms can prevent recurrence of bacterial vaginosis.
Testing and treatment of partners of those with bacterial vaginosis have not been demonstrated to be beneficial.
Treatment of asymptomatic patients is not recommended, as antibiotics may induce gastrointestinal adverse effects, allergic reactions or vulvovaginal candidiasis.