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Vulvovaginitis

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.

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.

Preparation  and evaluation of 10% potassium hydroxide and 0.9% saline wet mounts provide strategies for diagnosis.

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.

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