Trichomonas vaginalis organisms may be noted in a fresh wet preparation made by diluting the secretions with normal saline and examining the preparation under a microscope.
TREATMENTFlagyl® (metronidazole) is administered in 250-mg doses 3 times a day for 1 week. However, this drug is contraindicated in pregnancy and should, therefore, not be administered until pregnancy has been ruled out. A vinegar douche (2 tablespoons of vinegar to 1 quart of warm water) administered once or twice a week may prove beneficial.
Monilia VaginitisThis inflammation is the result of an overgrowth of the Candida albicans yeast, History may show a recent period of antibiotic therapy. Yeast infections are more common in warm, moist climates. Patients with persistent or recurrent monilial infections should be investigated for possible diabetes.
SYMPTOMSThe discharge is most often thick, curdlike, white in color, and may have a musty order. This discharge is not usually as profuse as the discharge of Trichomonas. Visual examination may reveal a red, inflamed vaginal mucosa, with white or grayish patches of discharge. When these patches are scraped off, there is frequently a small amount of bleeding. Vulvar irritation, itching, vaginismus, and dyspareunia are common. Preparation of a wet smear with 15 percent potassium hydroxide added will help to visualize the Candida hyphae and spores.
TREATMENTMONISTAT® 7 vaginal cream (miconazole nitrate 2 percent) administered once daily over a 2-week period is the treatment of choice. Hydrocortisone 1 percent cream applied locally to the vulva 3 times a day will help to relieve local irritation and itching. Mycostatin® vaginal tablets taken once daily at bedtime for 15 days may also be used.
Bacterial VaginitisThe etiologic agent may range from Haemophilus vaginitis to Neisseria gonorrhea and a wide range of other bacteria.
SYMPTOMSThe discharge in this form of vaginitis may range from scanty to profuse, may have a foul or musty odor, maybe viscid to watery in consistency, and the color may range from greenish-yellow, brown, pink, gray, or milky white. The vaginal mucosa may be red and swollen, but this is not always true. Vulvitis, urethritis, and ulceration of the cervix are commonly accompanying symptoms. Infections of the Bartholins and Skenes glands are common, especially in gonorrhea infections. A purulent discharge is often seen exuding from the cervical OS, and pain and swelling of the cervix itself is often noted. The only definitive method of determining the specific etiologic agent is through a culture.
TREATMENTGeneral measures consist of perineal and vulvar hygiene to control pruritus and local itching. Specific measures include vaginal application of sulfa creams once daily for 2 weeks. Ampicillin taken orally may also be beneficial.
When the causative agent is unknown, a broad-spectrum drug such as Betadine® vaginal gel may prove effective in treating any of the more commonly encountered types of vaginitis. A culture for Neisseria gonorrhea should always be considered in sexually-active women.
This is an inflammation of the vulvar region. The causes include mechanical and chemical irritation; hygiene neglect; urinary, fecal, or vaginal contamination; allergic reactions to detergents or drugs; parasitic infestations (pediculosis pubis); herpes simplex; psoriasis; condylomata acuminata; and folliculitis.
SYMPTOMSThey include burning, severe pain, pruritus, redness, swelling, ulceration, pustular formation, edema, and vesicular itching. Areas of irritation may extend to the perineal region and the inner areas of the thighs.
TREATMENTWhen a specific infection exists, treat the cause. Symptomatic relief may be obtained by the use of cool compresses of Burows solution or tepid sitz baths. The area should be kept as clean and dry as possible, and the use of soaps and other harsh cleansing agents should be avoided, as they tend to dry the tissues and increase irritation. If an allergic reaction is the suspected cause, oral antihistamines may prove beneficial. Hydrocortisone 1 percent cream is often helpful. Chronic or intractable cases should be referred to a medical treatment facility as soon as possible.