Infectious Disease
Vulvovaginitis
#Vulvovaginitis
Intake
- Description: *** burning, itching, dysuria, discharge,
- Onset: ***
- Associated Symptoms: *** discharge (color, consistency, odor), bleeding/spotting, dysuria, abdominal pain, back pain, pain with intercourse
- Sexual History: *** sexually active, # partners, protection, h/o STIs
- Lifestyle: *** new soaps, lotions, detergents, vaginal cleansers, sanitary products
- Prior Episodes: ***
- Notable PMH: *** endometriosis, fibroids, immunosuppression (HIV, diabetes)
- Meds: *** recent abx, steroids, OTC meds
Plan
- Wet mount and KOH prep
- If c/f STI - Gonorrhea and chlamydia NAAT
- If c/f menopause - FSH to confirm
- Yeast infection - fluconazole 150mg PO once
- Bacterial Vaginosis - metronidazole 500mg PO BID for 7 days OR metronidazole 0.75% gel intravaginally once daily for 5 days
- Trichomoniasis - metronidazole 2g PO once
- Atrophic vaginitis - topical estrogen therapy (conjugated estrogen cream 0.5g intravaginally 1-3 times per week)
Differential
Infectious
- Candida (Yeast) Infection
- Bacterial Vaginosis (gardnerella)
- Trichomoniasis
- STI (chlamydia, gonorrhea)
Non-Infectious
- Atrophic vaginitis (post-menopausal)
- Allergic Reaction/Contact Dermatitis
- Lichen Sclerosis
- Vulvodynia
Template coming soon!
Patient Guidance and Information
Diagnosis of Vulvovaginitis
Based on your symptoms, you have vulvovaginitis or inflammation of the vulva and vagina. This condition is common and can cause symptoms including itching, burning, discomfort, and discharge. It is often caused by an infection, but can also be caused by other irritants.
You’ve been prescribed ***. Please take *** and be sure to finish the entire course, even if you start to feel better before the medication runs out.
Continue to keep the vaginal area clean and dry and avoid douching as it can disrupt the balance of natural healthy bacteria in the vagina. Loose-fitting clothing can also help the area dry and prevent irritation.
Please let our office know if your symptoms have not improved by the end of the treatment course, or if your symptoms worsen.
If You Remember Nothing Else
Conduct a thorough history, including onset and characteristics of symptoms, sexual history, personal hygiene practices, and recent product use. A detailed physical exam is a must, focusing on discharge, lesions, erythema, or edema. Key tests include wet mount, KOH prep, vaginal pH, and when indicated, NAAT for STIs. For treatment, tailor the therapy to the specific cause: antifungals for yeast, antibiotics for bacterial vaginosis or trichomoniasis, and often just cessation of an irritant for contact dermatitis. Educate patients on proper genital hygiene, and always have a follow-up plan to ensure resolution.
Clinical Pearls
- Burning is more associated with a yeast infection or bacterial vaginosis; intense itch more associated with parasitic infections like trichomoniasis
- Clue cells (epithelial cells covered with bacteria) on wet mount are diagnostic for bacterial vaginosis; men are not treated for BV, but can be asymptomatic carriers
- Not all yeast infections are caused by Candida albicans. Non-albicans Candida species (like Candida glabrata) may be resistant to azole therapies
- Discharge: thick white - yeast infection; thin, grayish-white, foul-smelling - bacterial vaginosis; greenish-yellow discharge - trichomoniasis
- Douching or use of soaps can disrupt vaginal flora leading to an increased risk of infection like BV; new products can also cause allergic reactions or contact dermatitis
- Recent treatment with abx for a UTI is a set up for a yeast infection
- The hormonal changes during menopause can cause thinning and drying of the vaginal walls (atrophic vaginitis), leading to itching or discomfort
- "Whiff Test" (amine odor when KOH is added to vaginal secretions) that's positive suggests bacterial vaginosis
- Vaginal pH is elevated in BV and trichomoniasis but usually normal in yeast infection
Trials and Literature
Other Resources
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