Abstract
Vulvovaginitis is the most common reason why women present to a gynecologist. The term covers inflammation or infection of the vagina and/or vulva. Women with symptoms lasting for more than 6 months experience chronic vulvovaginitis. The clinical presentation of women with vulvovaginitis is similar regardless of the underlying cause and so a careful history is important. Symptoms include itching, discharge, irritation, dysuria, vaginal odor, rash, and burning. Other findings on exam include erythema, edema and excoriation of the vulvar skin, ulceration, or chronic vulvar skin changes. The following investigations can aid diagnosis: vaginal pH, amine whiff test, vulvar biopsy, fungal cultures, and wet smears. Causes fall into four main groups, infections, dermatoses, atrophy, and neoplasia. Infectious causes include bacterial vaginosis, vulvovaginal candidiasis, Trichomonas vaginalis, and threadworms (pinworms). Symptoms will improve following effective treatment of the infection. Vaginal atrophy is a result of estrogen deficiency and is improved with estrogen replacement. Dermatoses include lichen sclerosus, lichen planus, contact dermatitis, and lichen simplex. Treatment of dermatoses includes steroids, topical estrogens, tacrolimus ointment, retinoids, and emollients. All women will benefit from good vulvar skin care and emotional support.
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References
Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK, Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. 1983;74(1):14–22.
Bosserman EA, Helms DJ, Mosure DJ, et al. Utility of antimicrobial susceptibility testing in Trichomonas vaginalis-infected women with clinical treatment failure. Sex Transm Dis. 2011;38:983–7.
Bradshaw CS, Morton AN, Hocking J, Garland SM, Morris MB, Moss LM, Horvath LB, Kuzevska I, Fairley CK. High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence. J Infect Dis. 2006;193(11):1478–86.
British Association of Sexual Health and HIV effectiveness Group. Management of vulvoaginal candidiasis. 2007. http://www.bashh.org/documents/1078. Accessed Aug 2016.
British Association of Sexual Health and HIV effectiveness Group. Management of Bacterial vaginosis. 2012. http://www.bashh.org/documents/4413. Accessed Aug 2016.
British Association of Sexual Health and HIV effectiveness Group. United Kingdom National Guideline on the Management of Trichoonas Vaginalis. 2014a. http://www.bashh.org/documents/UK%20national%20guideline%20on%20the%20management%20of%20TV%20%202014.pdf. Accessed Aug 2016.
British Association of Sexual Health and HIV effectiveness Group. United Kingdom National Guideline on the Management of Vulval conditions. 2014b. http://www.bashh.org/documents/UK%20national%20guideline%20for%20the%20management%20of%20vulval%20conditions%202014.pdf. Accessed Aug 2016.
British Menopause Society HRT Guide Post NICE Guidance for Healthcare Professionals. 2016. https://thebms.org.uk/_wprs/wp-content/uploads/2016/04/HRT-Guide-160516.pdf. Accessed Aug 2016.
Calzolari E, Masciangelo R, Milite V, Verteramo R. Bacterial vaginosis and contraceptive methods. Int J Gynaecol Obstet. 2000;70:341–6.
Cooper SM, Wojnarwowska F. Influence of treatment of erosive lichen planus of the vulva on its prognosis. Arch Dermatol. 2006;142:362–4.
Duerr A, Heilig CM, Meikle S, Cu-Uvin S, Kliein RS, Rompalo A, et al. Incident and persistent vulvovaginal candidiasis among human immunodeficiency virus affected women: risk factors and severity. Obstet Gynecol. 2003;101:548–56.
Faculty of Sexual and Reproductive Healthcare Clinical Guidance. Management of vaginal discharge in non-genitourinary medicine settings. 2012.
Faro S, Apuzzio J, Bohannon N, et al. Treatment considerations in vulvocandidiasis. Female Patient. 1997;22:21–38.
Fethers K, Fairley CK, Morton A, Hocking JS, Kennedy LJ, et al. Early sexual experiences and risk factors for bacterial vaginosis compared with vaginal candidiasis. Obstet Gynecol. 2005;106:105–14.
Fethers K, Fairley CK, Hocking JS, Gurrin LC, Bradshaw CS. Sexual risk factors and bacterial vaginosis: a systemic review and meta-analysis. Clin Infect Dis. 2008;47:1426–35.
Fong IW. The value of treating the sexual partners of women with recurrent vaginal candidiasis with ketoconazole. Genitourin Med. 1992;68:174–6.
Forna F, Gulmezoglu AM. Interventions for treating tichomoniasis in women. Cochrane Database Syst Rev. 2003;(2):CD000218.
Fouts AC, Kraus SJ. Trichomonas vaginalis: re-evaluation of its clinical presentation and laboratory diagnosis. J Infect Dis. 1980;141:137–43.
Fredricks DN, Fiedler TL, Marrazzo JM. Molecular identification of bacteria associated with bacterial vaginosis. N Engl J Med. 2005;353(18):1899–911.
Genadry R, Provost T. Severe vulvar scarring in patients with erosive lichen planus: a report of 4 cases. J Reprod Med. 2006;51(1):67–72.
Goldstein AT, Metz A. Vulvar lichen planus. Clin Obstet Gynecol. 2005;48:818–23.
Goswami R, Dadhwal V, Tejaswi S, Datta K, Paul A, Richaran RN, et al. Species specific prevalence of vaginal candidiasis among patients with diabetes mellitus and its relation to glycaemic status. J Infect. 2000;41:162–6.
Haefner HK. Current evaluation and management of vulvovaginitis. Clin Obstet Gynaecol. 1999;42(2):184–95.
Ibarra J. Threadworms: a starting point for family hygiene. Br J Community Nurs. 2001;6(8):414–20.
Ison CA, Hay PE. Validation of a simplified grading of Gram stained vaginal smears for use in genitourinary medicine clinics. Sex Transm Infect. 2002;78(6):413–5.
Kent HL. Epidemiology of vaginitis. Am J Obstet Gynecol. 1991;165(4):1168–76.
Kingston A. The postmenopausal vulva. Obstet Gynecol. 2009;11:253–9.
Kingston MA, Bansal D, Carlin EM. ‘Shelf life’ of Trichomonas vaginalis. Int J STD AIDS. 2003;14:28–9.
Kirkcaldy RD, Augostini P, Asbel LE, et al. Trichomonas vaginalis antimicrobial drug resistance in 6 US cities, STD surveillance network, 2009–2010. Emerg Infect Dis. 2012;18:939–43.
Klatt TE, Cole DC, Eastwood DC, Barnabei VM. Factors associated with recurrent bacterial vaginosis. J Reprod Med. 2010;55(1–2):55–61.
Meyrick-Thomas RH, Ridley CM, McGibbon DH, Black MM. Lichen sclerosus and autoimmunity – a study of 350 women. Br J Dermatol. 1988;118:41–6.
National Institute for Health Care Excellence Menopause: diagnosis and management 2015.
Neill SM, Tatnall FM, Cox NH. Guidelines for the management of lichen sclerosus. Br J Dermatol. 2002;147:640–9.
Nye MB, Schwebke JR, Body BA. Comparison of APTIMA Trichomonas vaginalis transcription-mediated amplification to wet mount microscopy, culture, and polymerase chain reaction for diagnosis of trichomoniasis in men and women. Am J Obstet Gynecol. 2009;200(188):e181–7.
Nyirjesy P. Chronic vulvovaginal candidiasis. Am Fam Physician. 2001;63(4):697–702.
Nyirjesy P, Seeney SM, Grody MH, Jordan CA, Buckley HR. Chronic fungal vaginitis: the value of cultures. Am J Obstet Gynecol. 1995;173:820–3.
Nyirjesy P, Weitz MV, Grody MH, Lorber B. Over-the-counter and alternative medicines in the treatment of chronic vaginal symptoms. Obstet Gynecol. 1997;90:50–3.
O’Connor MI, Sobel JD. Epidemiology of recurrent vulvovaginal candidiasis: identification and strain differentiation of Candida albicans. J Infect Dis. 1986;154:358–63.
Oyama N, Chan I, Neill SM, et al. Autoantibodies to extracellular matrix protein 1 in lichen sclerosus. Lancet. 2003;362:118–23.
Sobel JD, Faro S, Force RW, Foxman B, Ledger WJ, Nyirjesy PR, et al. Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations. Am J Obstet Gynecol. 1998;178(2):203–11.
Sturdee DW, Panay N. Recommendations for the management of postmenopausal vaginal atrophy. Climacteric. 2010;13(6):509–22.
Summers P, Hunn J. Unique dermatologic aspects of the postmenopausal vulva. Clin Obstet Gynecol. 2007;50(3):745–51.
Swidsinski A, Mendling W, Loening-Baucke V, Ladhoff A, Swidsinski S, Hale LP, et al. Adherent biofilms in bacterial vaginosis. Obstet Gynecol. 2005;106(5):1013–23.
Vazquez JA, Sobel JD, Demitriou R, Vaishampayan J, Lynch M, Zervos MJ. Karyotyping of Candida albicans isolates obtained longitudinally in women with recurrent vulvovaginal candidiasis. J Infect Dis. 1994;170:1566–9.
Wolner-Hanssen P, Kreiger JN, Stevens CE, et al. Clinical manifestations of vaginal trichomoniasis. JAMA. 1989;264:571–6.
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Kingston, A., Torbé, E. (2023). Management of Chronic Recurrent Vulvovaginitis. In: Shoupe, D. (eds) Handbook of Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-031-14881-1_26
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DOI: https://doi.org/10.1007/978-3-031-14881-1_26
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