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Inflammatory Vaginitis


Oluwatosin Goje

, MD, MSCR, Cleveland Clinic, Lerner College of Medicine of Case Western Reserve University

Last full review/revision Apr 2021| Content last modified Sep 2022
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Inflammatory vaginitis is vaginal inflammation without evidence of the usual infectious causes of vaginitis.

Etiology of inflammatory vaginitis may be autoimmune.

Vaginal epithelial cells slough superficially, and streptococci overgrow.

The major risk factor for inflammatory vaginitis is

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.

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