Vaginitis is inflammation or infection of the vagina.
Common symptoms of vaginitis include itching, irritation, and abnormal vaginal discharge that may have an unpleasant smell. Some patients may experience vaginal pain with sexual intercourse. The 3 most common causes of premenopausal vaginitis are vulvovaginal candidiasis, bacterial vaginosis, and trichomoniasis, which account for more than 70% of cases of vaginitis.
How Is Vaginitis Diagnosed?
Vaginitis is typically diagnosed through a patient’s history, physical examination, pH testing of vaginal discharge, and examination of vaginal discharge under a microscope (microscopy). In addition, vaginal or cervical swabs obtained by a clinician or patient can be analyzed using advanced laboratory techniques (nucleic acid amplification testing [NAAT]) to identify organisms that cause vaginitis and to test for gonorrhea and chlamydia, which are common causes of sexually transmitted infections.
What Is Vulvovaginal Candidiasis?
Vulvovaginal candidiasis, commonly known as a yeast infection, is a fungal infection of the vagina. Common risk factors for vulvovaginal candidiasis include diabetes or recent use of antibiotics or steroids. About 90% of affected patients have uncomplicated vulvovaginal candidiasis, which can be treated with an over-the-counter antifungal medication given vaginally or as a single dose of prescribed oral fluconazole. Both treatments have cure rates of 80% to 90%; however, oral fluconazole is not approved for use during pregnancy.
What Is Bacterial Vaginosis?
Bacterial vaginosis is a condition that results from the overgrowth of normal bacteria in the vagina and that often causes vaginal discharge with a characteristic “fishy” odor. Risk factors for bacterial vaginosis include sexual activity, lack of condom use, having female sexual partners, and douching, as these activities temporarily change the bacteria in the vagina. Although bacterial vaginosis may resolve spontaneously, individuals experiencing symptoms of ongoing vaginal irritation, discharge, or odor may be treated with an antibiotic given orally (metronidazole) or vaginally (metronidazole or clindamycin). These medications have cure rates of approximately 80%, are safe in pregnancy, and are associated with a decreased risk of sexually transmitted infections. Condom use is recommended to reduce the risk of recurrent bacterial vaginosis.
Trichomoniasis is a sexually transmitted infection. Common symptoms include vaginal irritation and yellow-green discharge; however, some patients may be asymptomatic. Risk factors for trichomoniasis include multiple sexual partners and sexual activity without condom use. Treatment requires oral medication for both patients and their sexual partners. The preferred regimen is oral metronidazole twice daily for 1 week; however, a single large dose of metronidazole can be given to individuals who are unlikely or unable to complete a week-long course of antibiotics. Sexual abstinence is recommended for at least 7 days after treatment, and patients with trichomoniasis should be tested again in 3 months because reinfection is common.
Which Patients With Vaginitis Should See a Gynecologist?
Patients with more than 3 episodes of vaginitis per year or vaginal symptoms that do not improve with treatment and those with abnormal-appearing skin in the vulvar area should be evaluated by a gynecologic specialist. Pregnant individuals with vaginitis should seek treatment with their obstetric clinician.
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Conflict of Interest Disclosures: None reported.
Source: Leclair C, Stenson A. Common causes of vaginitis. JAMA. Published June 14, 2022. doi:10.1001/jama.2022.6375