Vaginitis and Vaginal Discharge

VAGINITIS AND VAGINAL DISCHARGE

Symptomatic vaginal discharge may occur alone or accompany salpingitis, endometritis, and cervicitis. Evaluation includes pelvic examination, cervical cultures for N. gonor-rhoeae and C. trachomatis, and microscopic examination of the discharge. Measurementof the pH of the discharge may also be helpful. Pelvic examination is valuable in deter-mining whether uterine, adnexal, or cervical tenderness is present and whether the source of the discharge is the cervix or the vagina.

The clinical and laboratory findings vary with the etiologic agent. Candida albicans generally produces a vulvovaginitis associated with pruritus and erythema of the vulvar area and a discharge with the consistency of cottage cheese. Microscopic demonstration of yeast and pseudomycelia in a potassium hydroxide or Gram stain preparation of the exudate confirms the diagnosis. Trichomonas vaginalis typically produces a foamy, puru-lent vaginal discharge. The pH is variable (usually >5.0), and numerous polymorphonu-clear cells and motile trichomonads are seen on wet mount examination.

Bacterial vaginosis (BV), previously termed “nonspecific vaginitis,” is the most com-mon form of vaginitis in women. BV is associated with overgrowth of multiple members of the vaginal anaerobic flora, genital mycoplasmas, and a small Gram-negative rod (Gardnerella vaginalis), once believed to be the sole cause of the disease. The vaginal discharge of BV is yellowish, homogenous, and adherent to the vaginal wall. The pH is greater than 5.0. Addition of KOH to the vaginal secretions produces a fishy smell as a result of volatilization of amines. The Gram stain shows a shift from the usual lactobacil-lary flora to one of many Gram-negative coccobacilli. Clue cells, which are vaginal epithelial cells heavily coated with G. vaginalis, may also be seen. Therapy depends on the etiologic agent.