Merck Manual

Please confirm that you are a health care professional

Yes No

Leave this Site?

The link you have selected will take you to a third-party website. We do not control or have responsibility for the content of any third-party site.

Continue Cancel
honeypot link
Merck Manual
Professional Version
The trusted provider of medical information since 1899
Medical Topics & Chapters
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
Professional /
Gynecology and Obstetrics /
Vaginitis, Cervicitis, and Pelvic Inflammatory Disease (PID) /
... /
Inflammatory Vaginitis /
IN THIS TOPIC

Symptoms and Signs

Diagnosis

Treatment

OTHER TOPICS IN THIS CHAPTER

Vaginitis, Cervicitis, and Pelvic Inflammatory Disease (PID)
Overview of Vaginitis
Bacterial Vaginosis (BV)
Candidal Vaginitis
Cervicitis
Inflammatory Vaginitis
Pelvic Inflammatory Disease (PID)

ADDITIONAL CONTENT

Test your knowledge

Menopause
Which of the following is the most effective treatment for relieving symptoms associated with menopause? 
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID

More Content

Inflammatory Vaginitis

By

Oluwatosin Goje

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

Last full review/revision Apr 2021| Content last modified Apr 2021
Click here for Patient Education

Inflammatory vaginitis is vaginal inflammation without evidence of the usual infectious causes of vaginitis.

(See also Overview 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

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

  • 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

  • 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

Drug Name Select Trade
Clindamycin
 CLEOCIN
estradiol
 ESTRADERM, ESTROGEL, VIVELLE
estrogens
 Estrogens
Click here for Patient Education
NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
© 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA)
Cervicitis
Pelvic Inflammatory Disease (PID)
Professionals also read
Overview of Vaginitis Overview of Vaginitis
Vaginal Itching and Discharge Vaginal Itching and Discharge
Vaginal Bleeding Vaginal Bleeding

Also of Interest

 

Merck and the Merck Manuals

Merck & Co., Inc., Kenilworth, NJ, USA is a global healthcare leader working to help the world be well. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world.  The Merck Manual was first published in 1899 as a service to the community.  The legacy of this great resource continues as the Merck Manual in the US and Canada and the MSD Manual outside of North America.  Learn more about our commitment to Global Medical Knowledge.

View Privacy Shield Verification Status
View APEC CBPR Privacy Certification Status

This website is certified by Health On the Net Foundation. Click to verify. This site complies with the HONcode standard for trustworthy health information:  
verify here.

© 2021 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA
TOP