Vulvovaginitis: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
===Workup=== | ===Workup=== | ||
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*Evaluate for infectious causes with cultures, wet mount, and trichomonas NAAT (or molecular vaginitis panel) | *Evaluate for infectious causes with cultures, wet mount, and trichomonas NAAT (or molecular vaginitis panel) | ||
**Respiratory or enteric flora may be seen in vaginal cultures from pre-puberal females | **Respiratory or enteric flora may be seen in vaginal cultures from pre-puberal females | ||
Revision as of 20:50, 19 June 2024
Background
- Definition: inflammation of the vulva and vagina
- Candida Vaginitis and Contact Vulvovaginitis may occur in pre-pubertal and non-sexually active people
- Atrophic vaginitis may occur in postmenopausal women
Vulvovaginitis
- Bacterial vaginosis
- Candida vaginitis
- Trichomonas vaginalis
- Contact vulvovaginitis
- Bubble baths and soaps
- Deodorants, powders, and douches
- Clothing
- Atrophic vaginitis due to lack of estrogen (AKA Vulvovaginal atrophy)
- Lichen sclerosus
- Tinea cruris
- Chlamydia/Gonorrhea infection
- Pinworms
- Vaginal foreign body
- Toilet paper
- Other
- Genitourinary syndrome of menopause
- Foreign body
- Allergic reaction
- Normal physiologic discharge
Clinical Features
- Nonspecific
- Discharge
- Itching
- Erythema or rash
- Dysuria
- Odor
- Pain with intercourse
Differential Diagnosis
Acute Pelvic Pain
Gynecologic/Obstetric
- Normal variants may be noted on exam but generally do not cause pain or other symptoms
- Nabothian cysts: Epithelial cells within mucous glans that appear as yellow inclusions on the cervix
- Cervical Ectropion: Edothelial cells on the exterior of the cervix
- Parous cervix: The is no longer round but may have multiple shapes after birth
- Pregnancy-related
- Ectopic pregnancy
- Spontaneous abortion, threatened or incomplete
- Septic abortion
- Pelvic organ prolapse
- Acute Infections
- Vulvovaginitis
- Adnexal Disorders
- Hemorrhage/rupture of ovarian cyst
- Ovarian torsion
- Twisted paraovarian cyst
- Other
- Myoma (degenerating)
- Genitourinary trauma
- Ovarian hyperstimulation syndrome
- Sexual assault
- Recurrent
- Mittelschmerz
- Primary/Secondary Dysmenorrhea
- Pelvic Congestion Syndrome
- Endometriosis
Genitourinary
Gastrointestinal
- Gastroenteritis
- Appendicitis
- Bowel obstruction
- Perirectal abscess
- Diverticulitis
- Inflammatory bowel disease
- Irritable bowel syndrome
- Mesenteric adenitis
Musculoskeletal
- Abdominal wall hematoma
- Psoas hematoma, psoas abscess
- Hernia
Vascular
- Pelvic thrombophlebitis
- Abdominal aortic aneurysm
- Ischemic bowel (Mesenteric Ischemia)
Evaluation
Workup
- Upreg
- Evaluate for infectious causes with cultures, wet mount, and trichomonas NAAT (or molecular vaginitis panel)
- Respiratory or enteric flora may be seen in vaginal cultures from pre-puberal females
- Respiratory: Staph, Strep, H influenza, Moraxella, and N meningitidis
- Enteric: E coli, proteus, klebsiella, shigella etc.
- STIs are less common
- Candida and gardnerella may be see on wet mount
- Respiratory or enteric flora may be seen in vaginal cultures from pre-puberal females
- Consider O&P
- Pinworms may cause vulvovaginitis in children [2]
Diagnosis
Management
Empiric Treatment
- Acceptable when clinically suspecting BV, vaginal candidiasis, or a non-infectious etiology
- If signs/symptoms are equivocal for a specific diagnosis or if they suggest possible trichomoniasis, diagnostic testing should first be performed prior to treatment.
Non-Infectious Etiology Treatment
- Hygienic measures for non-specific vulvovaginitis particularly in pre-pubertal females
- OTC Vaginal lubrication products for post-menopausal women with vulvovaginal atrophy symptoms [3]
- Consider hormone replacement therapy in post-menopausal women
- Best provided by a primary care provider
Treatment for Test-Positive Patients based on Organism and Symptomatology
| Positive Organism | Symptomatic | Asymptomatic | Test of cure needed? | Treat sexual partner(s)? |
|---|---|---|---|---|
| BV | Treat | Do not treat | No, unless persistent symptoms | No |
| Vaginal candidiasis | Treat | Do not treat | No, unless persistent symptoms | No |
| Trichomoniasis | Treat | Treat | Yes (in 3 months; use NAAT) | Yes |
Disposition
- Virtually all patients can be discharges with PCP or Gyn follow up
- Any test sent should be followed for results
See Also
External Links
- ACOG patient information for vaginitis [1]
References
- ↑ Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.
- ↑ Loveless M, Myint O. Vulvovaginitis- presentation of more common problems in pediatric and adolescent gynecology. Best Pract Res Clin Obstet Gynaecol. 2018 Apr;48:14-27. doi: 10.1016/j.bpobgyn.2017.08.014. Epub 2017 Sep 5. PMID: 28927766.
- ↑ Alvisi S, Gava G, Orsili I, Giacomelli G, Baldassarre M, Seracchioli R, Meriggiola MC. Vaginal Health in Menopausal Women. Medicina (Kaunas). 2019 Sep 20;55(10):615. doi: 10.3390/medicina55100615. PMID: 31547180; PMCID: PMC6843679.