VAGINITIS

Definition: Infectious disease affecting the vagina,only rarely affecting the vulva.

Causes:

 Polymicrobial; Gardenella Vaginalis, Mobiluncus species, Mycoplasma

 Hominis, Peptostreptococcus, other various anaerobes , including Prevotella,
Bacteroides ,and
 Fusobacterium.
 There is shift from a healthy lactobacilli based endogenous flora to
anaerobically based
 endogenous flora.
 Rectal reservoir of organism leading to autoinfection.

Risk factors: Controversial regarding multiple sexual partners

IUD.
Signs and Symptoms:

 Unpleasant vaginal odour,musty or fishy, exacerbated immediately after

intercourse.
 Thin gray white vaginal discharge, mildle adherentto vaginal walls.
 10-30% with vaginal/vulval irritation.
 10% with froathy discharge.
DIFFERENTIAL DIAGNOSIS

 N.Gonorrhoea.
 Chlamydia.
 Trichomonas.
 E.Coli.
 Staphylococci.
 Fungal.

Lab Investigation:

Examination of the vaginal discharge by saline wet mouth -

 A drop of discharge is collected by pipette is mixed with saline on a warm
glass slide & a cover
 slide is placed over it. The wet film is immediately examined under hig
power microscope when
 the parasites are recognised by the rotatory movements.
 Plenty of pus cells, organisms,
 epithelial cells are seen on

Treatment:

 Metronidazole 500 mg bid for 7 days

 Clindamycin 450 mg tds for 7 days or 2% vaginal cream for 7 days,or
metronidazole
  vaginal cream for bacterial vaginosis.
 Flagyl is given to husband if there is penile itching.
 During treatment period, sex act is suspended.
 Metronidazole course is followed by Tab Clotrimazole 100 mg inserted deep
in the vagina daily
 at bed time for 6 nights.
 For vulval itching Surfaz Cream or Candid V gel is applied on vulva twice
daily for 10 days.

Prevention:

 Maintain good hygeine.

 Use of condoms for sexual intercourse.

Complications:
Uncommon but include :
 adnexal tenderness
 PID
 Intrauterine infections