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vaginitis(vaj?i-nit'is) [ vagina + -itis]
Inflammation of the vagina may be caused by overgrowth or invasion of microorganisms such as gonococci, Chlamydiae, Gardnerella vaginalis, staphylococci, streptococci, spirochetes; viruses such as herpes; irritation from chemicals in douching, hygiene sprays, detergents, menstrual products, or toilet tissue; fungal infection (candidiasis) caused by overgrowth of Candida albicans or, less commonly, other candidal species; protozoal infection, e.g., Trichomonas vaginalis; neoplasms of the cervix or vagina; poor hygiene; irritation from foreign bodies, e.g., a pessary or a retained tampon; or vulvar atrophy. Other, rare, causes are parasitic illnesses, or, in malnourished women, pellagra.
The patient experiences vaginal discharge, sometimes malodorous and occasionally stained with blood; irritation, burning, or itching; increased urinary frequency; and pain during urination or examination. On examination, the vaginal mucous membrane is reddened, and there may be superficial maceration or ulceration.
Specific therapy is given as indicated for the underlying cause. Improved perineal hygiene is emphasized by instructing in the proper method of cleaning the anus after a bowel movement, the proper use of menstrual protection materials, and the necessity of drying the vulva following urination.
In addition to being taught improved perineal hygiene, patients should be encouraged to wear all-cotton underpants or panties with a cotton crotch area, not to wear underwear to bed, and to avoid tight-fitting pants or panty hose that promote moisture and growth of organisms .
During examination of the patient, aseptic techniques are used to collect specimens. The health care provider supports the patient throughout the procedures, explaining each procedure and warning the patient of possible discomfort. The patient should be advised that persistent or recurrent candidiasis indicates a need for assessment for pregnancy or diabetes mellitus. If vaginitis is due to a sexually transmitted disease, the sexual partner should receive treatment with the patient to prevent reinfection. Certain sexually transmitted vaginal infections must be reported to local or state public health officials with the patient's known sexual contacts.
Symptoms include burning and pain during intercourse. Estrogen replacement therapy, hormone replacement therapy, or application of topical estrogen restores the integrity of the vaginal epithelium and supporting tissues and relieves symptoms.
Symptoms include a thick, curdlike adherent discharge; itching; dysuria; and dyspareunia. The vulva and vagina are bright red. History usually reveals one or more risk factors: use of oral contraceptives or broad-spectrum antibiotics; immune defects; diabetes mellitus; pregnancy; or frequent douching. Diagnosis is established by the presence of hyphe and buds on a wet smear treated with 10% potassium solution, a pH of 4.5 or less, and/or of growth of culture on Nickerson's or Sabouraud's media. Treatment may include the use of topical or oral antifungal agents, or both. Oral fluconazole, given once, or topical applications of miconazole, clotrimazole, butoconazole, or terconazole, given 3 to 7 days, promptly relieve symptoms. Recurrence of symptoms after treatment is often due to presence of candida species other than C. albicans, presence of a mixed infection, or reinfection. Either use of a different agent or a longer course of treatment (14 to 21 days) is indicated, as well as testing for hyperglycemia. Synonym: moniliasis
Gardnerella vaginalis vaginitisBacterial vaginosis.
The diagnosis is established when clinical symptoms of vaginitis are present, but no organisms are found in laboratory specimens.