Ob-Gyn Clerkship: Week 3 Assigments

Vaginitis

Cause of the condition

The vaginitis result in inflammation of the vulva and vagina, the cause can be infectious or
noninfectious. The normal vaginal flora keeps the pH levels of the vaginal fluids low, because
this prevents the overgrowth of pathogenic organism. The disruption of the flora can be cause by
sexual intercourse predisposes to infection. The atrophic vaginitis es the most common of
noninfectious and this frequently affect elderly women after menopause cause by the reduction
of the estrogen levels. (1)

Common signs, symptoms, and presentations

When the patients have bacterial vulvovaginitis by Gardnerella vaginalis can by asymptomatic
but can have an increase vaginal discharge usually gray or milky with a fishy odor. If the patient
has a vaginal yeast infection by Candida albicans will present white, crumbly and sticky vaginal
discharge that may appear like “cottage cheese” and its odorless, erythematous vulva and vagina
and can present vaginal burning sensation, pruritus, dysuria and dyspareunia. If patient have a
trichomonas vaginalis present a foul smelling, yellow-green and purulent discharge, other
symptoms can be present a strawberry cervix, dyspareunia and dysuria. (1)

Pathophysiology
Candida vulvovaginitis occurs when the organism penetrates the mucosal lining of the vagina,
resulting in an inflammatory response. The inflammatory cells are polymorphonuclear cells and
macrophage (2). Bacterial vulvovaginitis can result in a lower concentration of Lactobacillus
acidophilus may lead to overgrowth of Gardnerella vaginalis and other anaerobes.

Diagnostic criteria and tests

Bacterial vaginitis can diagnose if 3 of the following Amsel criteria are met: identify in a wet
mount a Clue cell, vaginal pH >4.5 and a positive whiff test that it reflect with an intense fishy
odor and gray-white or yellow discharge. Vulvovaginal candidiasis on a wet mount with KOH
identify a pseudo hyphae and vaginal pH within normal range 4-4.5(2). Trichomonas vaginalis in
a saline wet mount identify a motile trophozoites with multiple flagella and pH of vaginal
discharge >4.5.

Treatments options
First line treatment for bacterial vaginosis is metronidazole 500mg orally twice a day for 7 days
or alternative treatment topical metronidazole gel 0.75% one full applicators intravaginally once
a day for 5 days or clindamycin cream 2% intravaginally at bedtime for 7 days. Yeast
vulvovaginitis topical azole: miconazole, clotrimazole or butoconazole or a single dose oral
fluconazole 150mg. Trichomoniasis vaginalis treatment metronidazole 2gm oral once a day or
tinidazole 2 gm oral once a day (1,2). Atrophic vaginitis treatments a nonhormonal vaginal
moisturizers and lubricants, vaginal estrogen therapy if moderate to severe symptoms. (3)
Prognosis
In most cases vaginitis has an excellent outcomes and cure but recurrent vaginal infections can
leads to chronic irritation, excoriations and scarring lead to sexual dysfunction. Many women
see some improvements with the use of intravaginal estrogen, risk factors for atrophic vaginitis
are no vaginal birth, cigarette smoking can cause vasoconstriction that lead to a decrease in
secretions and exacerbates symptoms. (1)

References
1. Hildebrand J, Kansagor A. Vaginitis. Ncbi.nlm.nih.gov.
https://www.ncbi.nlm.nih.gov/books/NBK470302/. Published 2021. Accessed January 29, 2021.

2. Jeanmonod R, Jeanmonod D. Vaginal Candidiasis. Ncbi.nlm.nih.gov.

https://www.ncbi.nlm.nih.gov/books/NBK459317/. Published 2021. Accessed January 29, 2021.

3. Flores S, Hall C. Atrophic Vaginitis. Ncbi.nlm.nih.gov.

https://www.ncbi.nlm.nih.gov/books/NBK564341/. Published 2021. Accessed January 29, 2021.