Vaginitis

Presentation

A patient presents for evaluation of vaginal discharge, possibly with itching and/or irritation of the labia and vagina. Odor, dysuria, vague low abdominal discomfort, or dyspareunia may be present.

Abdominal examination is benign, but examination of the introitus may reveal erythema of the vulva and edema of the labia, often with pustulopapular peripheral lesions (especially with Candida organisms). Speculum examination may disclose a diffusely red, inflamed vaginal mucosa with an adherent thick, white discharge resembling cottage cheese. These findings are also most likely the result of Candida organisms, especially when associated with vulvar pruritus.

A thin, homogeneous, gray-to-white milklike discharge smoothly coating the vaginal wall and having a fishy odor is characteristic of bacterial vaginosis (BV).

Profuse yellow-green or gray, sometimes frothy discharge with an unpleasant malodor and associated vulvar irritation is characteristic of Trichomonas organisms. Up to 70% of women infected with trichomonas, however, are asymptomatic. Cervical inspection may reveal a strawberry or punctate appearance.

Bimanual examination should demonstrate a nontender cervix and uterus, without adnexal tenderness or masses or pain on cervical motion (if present, see Chapter 91).

The appearance of the discharge is not pathognomonic, and testing needs to confirm any suspicion.