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8.03 Vaginitis


Presentation

A woman complains of itching and irritation of the labia and vagina, perhaps with vaginal discharge or odor, vague low abdominal discomfort, or dysuria. (Suprapubic discomfort and urinary urgency and frequency suggest cystitis.) Abdominal examination is benign but examination of the introitus may reveal erythema of the vulva and edema of the labia (especially with Candida). Speculum examination may disclose a diffusely red, inflamed vaginal mucosa, with vaginal discharge either copious, thin, and foul-smelling (characteristic of Trichomonas or anaerobic overgrowth) or thick, white, and cheesy (characteristic of Candida and associated with more intense vulvar pruritis). Bimanual examination should show a non-tender cervix and uterus, without adnexal tenderness or masses or pain on cervical motion.

What to do:

What not to do:

Discussion

Both Candida albicans and Gardnerella vaginalis (previously known as Hemophilus vaginalis or Corynebacterium vaginale), are part of the normal vaginal flora. A number of anaerobes share the blame in bacterial vaginosis. An alternate therapy uses active-culture yogurt douches to repopulate the vagina with lactobacilli. Candida vaginitis is more common in the summer, under tight or nonporous clothing (jeans, synthetic underwear, wet bathing suits), and in users of antibiotics and contraceptives (which alter vaginal mucus), as well as in diabetes mellitus, steroid-induced immuinosupression and use of broad-spectrum antibiotics. Trichomonas can be passed back and forth between sexual partners, a cycle that can be broken by treating both. Ask patients with vulvar pruritis, erythema and edema, but with otherwise normal saline, KOH and Gram stain microscopy, about the use of hygene sprays or douches, bubble baths or scented toilet tissue. Contact vulvovaginitis may result from an allergic or chemical reaction to any one of these or similar products and can be treated by removing the offending substance and prescribing a short course of a topical or systemic corticosteroid.

References:


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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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