LECTURE TOPIC: VAGINITIS

Vaginitis is a common presenting symptom seen in the

STD, Family Planning and Gynaecology clinics.

It is often characterised by vaginal discharge with

or without itching.

Vaginal discharge may be physiological or pathological in

origin.
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 Physiological causes

• Vaginal discharge is a continuum.

• Some patients do have copious discharge and others

may have little or no discharge.

• Thus, it is the patient who can determine what is the

normal amount of discharge for herself.

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• But normal vaginal discharge may increase
pre-menstrually, at ovulation time, when
on contraceptive pills or during pregnancy.

• The use of douches, deodorant or perfumed

soap may cause inflammation that may
result in vaginal discharge

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 Pathological causes:
The common causative agents of pathological
vaginal discharge are:

Candida albicans

Trichomonas vaginalis

Gardnerella vaginalis

Mobiluncus and anaerobes 4

These agents colonise the genital tract or are
usually sexually transmitted.

A woman coming to the clinic with a complaint of

vaginitis/vaginal discharge should be thoroughly
investigated, followed up and counseled where
necessary.

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 Candida albicans:
By far the commonest cause of vaginal discharge is
the Candida albicans ( 90 – 95% ). The condition is
also known as candidiasis, moniliasis or thrush.

Other species of Candida and other yeasts e.g.

Torulosis glabrata, may also be involved.

Contraction may be by sexual or non-sexual contact

Infection limited to labia, vulva and vaginal mucosa

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Signs and symptoms
Causes intense vaginal itching ( pruritis ) and cord-
like (cheesy) discharge

Also associated with pregnancy, diabetes mellitus,

antibiotic use, oral contraceptive, and
immunosuppression.

Causes soreness, redness and irritation of the penis

in men especially in the uncircumcised ones.

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 Laboratory diagnosis
Specimen
High vaginal swab (HVS):

Microscopy: Wet Prep – Budding yeast cells in the

presence or absence of pus cells

Gram stain – Gram positive yeast cells

Culture: Onto SAB agar at 370C for 48 hrs.

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Identification: Germ tube test: Pseudo hyphae

API Aux

Sensitivity test: Very sensitive to nystatin,

fluconazole, etc.
The antifungal drugs are poorly absorbed, so
treatment is usually topical with creams and
pessaries.

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 Trichomonas vaginalis
T. vaginalis infection is also known as
trichomoniasis. It presents with severe symptoms
in women.

The infection is nearly always sexually

transmitted

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• Signs and symptoms
Copious, frothy greenish foul smelling discharge
Moderate to severe vulval itching
May present with acute pelvic pain

Causes mild urethritis with occasional pin-prick

pain in the urethra in men.

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 Laboratory diagnosis
Specimen
High vaginal swab (HVS)

Microscopy
i) Wet Prep – Motile T. vaginalis and pus cells.
ii) Pap stain – Good morphology of T. vaginalis
iii) Acridine orange stain- Stains yellow
iv) Gram stain- Stains red
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Culture
- Can be done but not a routine test.

•Urine
Microscopy: Centrifuged urine – look for
motile T. vaginalis

Treatment: Usually with flagyl ( metronidazole )

and related drugs..

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 Gardnerella vaginalis
G. vaginalis causes a mild form of vaginitis.

It is characterized by light greenish vaginal

discharge with little or no itching.
It is believed to be a sexually transmitted disease.

Symptoms are absent in men.

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 Laboratory diagnosis
Specimen

High vaginal swab (HVS)

Microscopy – Wet Prep: “Clue” cells with few or no pus

cells

Gram stain: “clue” cells easier to recognize: vaginal

epithelial cell covered by numerous Gram variable small
rods.

Acridine orange stain: “Clue” cells stain yellow

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Culture
Columbia nalidixic acid human blood agar or Chocolate
agar, microaerophilic or CO2 incubation at 370C for 48
hours.
Beta haemolytic, catalase and oxidase negative.

Sensitivity – sensitive to metronidazole,

amoxacyline, clindamycin etc. Necessary to treat sexual
partners of patients.

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 Bacterial vaginosis
• A mixed bacterial flora of G. vaginalis,
Mobiluncus species and other anaerobes cause the
condition known as bacterial vaginosis.

• This condition used to be referred to as non-specific

vaginitis and it is a common syndrome in sexually
active females.

• Contraction is invariably by sexual contact.

• It is called vaginosis due to lack of inflammatory cells.

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• Signs and symptoms
It is mainly symptomised by thin
dirty vaginal discharge with very offensive fishy odour;
pH above 5.0. No pain or irritation.

- Men are usually asymptomatic.

• Laboratory diagnosis
• Specimen
High vaginal swab (HVS)

Microscopy – Same as for G. vaginalis.

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Culture

Same as for G. vaginalis but incubate anaerobically

Amine smell on addition of KOH

Sensitivity

Sensitive to metronidazole

Treat the partner of a positive case. etc.

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• Other less frequent aetiological agents of
pathological vaginal discharge (vaginitis)
include:

• Streptococcus group B:

• This organism colonises the vagina with little

or no symptoms i.e. very scanty or no
discharge.

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 It must be treated when isolated fromm a pregnant
woman because the baby can be infected during
delivery and so may develop neonatal meningitis
or sepsis.

Neisseria gonorrhoeae:

•This organism causes cervicitis accompanied by

cervical discharge which flows into the
vagina. N. gonorrhoeae does not infect the
vagina per se.
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Definitive laboratory diagnosis lies in the isolation and
identification of the
organism from HVS or cervical swab.

 Chlamydia trachomatis:
This organism causes cervical infection resulting in cervical
discharge which in turn flows down into the vagina.

It is diagnosed in the laboratory by tissue culture or

microscopy.

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Cervical lesions due to

i) Herpes (HSV),

ii)Genital warts(HPV)

iii)Syphilitic sores (T. pallidum)

may all result in the production of cervical

and vaginal discharge.

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