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.
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
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
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
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,
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
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