(See also Overview of Vaginitis Overview of Vaginitis Vaginitis is infectious or noninfectious inflammation of the vaginal mucosa, sometimes with inflammation of the vulva. Symptoms include vaginal discharge, irritation, pruritus, and erythema... read more .)
Etiology of inflammatory vaginitis may be autoimmune.
Vaginal epithelial cells slough superficially, and streptococci overgrow.
The major risk factor for inflammatory vaginitis is
Estrogen loss, which can result from menopause Menopause Menopause is physiologic or iatrogenic cessation of menses (amenorrhea) due to decreased ovarian function. Manifestations may include hot flushes, night sweats, sleep disruption, and genitourinary... read more or primary ovarian insufficiency Primary Ovarian Insufficiency In primary ovarian insufficiency, ovaries do not regularly release eggs and do not produce enough sex hormones despite high levels of circulating gonadotropins (especially follicle-stimulating... read more (premature ovarian failure—eg, due to oophorectomy, pelvic radiation, or chemotherapy)
Genital atrophy predisposes to inflammatory vaginitis and increases risk of recurrence.
Symptoms and Signs of Inflammatory Vaginitis
Purulent vaginal discharge, dyspareunia, dysuria, and vaginal irritation are common. Vaginal pruritus and erythema may occur. Burning, pain, or mild bleeding occurs less often. Vaginal tissue may appear thin and dry. Vaginitis may recur.
Diagnosis of Inflammatory Vaginitis
Vaginal pH and wet mount
Because symptoms of inflammatory vaginitis overlap with those of other forms of vaginitis, testing (eg, vaginal fluid pH measurement, microscopy, whiff test) is necessary.
Inflammatory vaginitis is diagnosed if
Vaginal fluid pH is > 6.
Whiff test is negative.
Microscopy shows predominantly white blood cells and parabasal cells.
Treatment of Inflammatory Vaginitis
Clindamycin vaginal cream
Treatment of inflammatory vaginitis is with clindamycin vaginal cream 5 g every evening for 2 weeks. After treatment with clindamycin, women are evaluated for genital atrophy. Genital atrophy, if present, can be treated with topical estrogens such as the following:
0.01% estradiol vaginal cream 2 to 4 g once a day for 1 to 2 weeks, followed by 1 to 2 g once a day for 1 to 2 weeks, then 1 g 1 to 3 times weekly
Estradiol hemihydrate vaginal tablets 10 mcg twice a week
Estradiol rings every 3 months
Topical therapy is usually preferred because of concerns about the safety of oral hormonal therapy; topical therapy may have fewer systemic effects.
Drugs Mentioned In This Article
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|ESTRADERM, ESTROGEL, VIVELLE|