Skip to main content
SpringerLink
Log in

Diagnosis and Treatment of Vulvovaginitis

  • Living reference work entry
  • First Online:
Handbook of Gynecology

  • 187 Accesses

Abstract

Vulvovaginitis symptoms are common and are the most frequent reason for visits to the obstetrician gynecologist. Vulvovaginitis symptoms are prevalent in a large range of age groups, and they can have a significant impact on women’s lives. The most common cause of vaginitis is bacterial vaginosis and the other two common causes are candida vaginitis and trichomoniasis. Together theses account for over 90 % of all vaginitis diagnosis. Self-diagnosis is common but often inaccurate. Vaginitis is associated with increased risk of acquiring a sexually transmitted disease or other female genital tract infections including human immunodeficiency virus (HIV). Theses concurrent conditions may result in infection of the upper genital tract and can lead to infertility as well as adverse reproductive and medical outcomes in pregnant and non pregnant women. Evaluation consists of a detailed focused history, physical exam, and appropriate diagnostic testing. Empiric therapy based on history and physical examination alone should be avoided because of frequent misdiagnosis and inappropriate therapy. Treatment should be chosen based on diagnostic findings and may be guided by cost, patient convenience and patient preference and directed to treat the most common causes such as bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. A discussion on proper vaginal hygiene including gentle cleaning and drying the vulvar area may be useful.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Similar content being viewed by others

References

  • American College of Obstetricians and Gynecologists: Vaginitis. Practice Bulletin No. 72, Obstet Gynecol. 2006;107:1195, Reaffirmed 2015, 2008.

    Google Scholar 

  • Bachman G, Santen RJ. Clinical manifestations and diagnosis of genitourinary syndrome of menopause (vulvovaginal atrophy). Clinical manifestations and diagnosis of genitourinary syndrome of menopause (vulvovaginal atrophy). 2016a. Available from Web. 28 June 2016. http://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-genitourinary-syndrome-of-menopause-vulvovaginal-atrophy

  • Bachman G. Santen RJ. Treatment of genitourinary syndrome of menopause (vulvovaginal atrophy). Treatment of genitourinary syndrome of menopause (vulvovaginal atrophy). 2016b. Available from Web. 28 June 2016, http://www.uptodate.com/contents/treatment-of-genitourinary-syndrome-of-menopause-vulvovaginal-atrophy

  • Baron EJ, Miller JM, Weinstein MP, et al. A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2013 recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)(a). Clin Infect Dis. 2013;57:e22.

    Article  PubMed  PubMed Central  Google Scholar 

  • Beigi RH, Austin MN, Meyn LA, Krohn MA, Hillier SL. Antimicrobial resistance associated with the treatment of bacterial vaginosis. Am J Obstet Gynecol. 2004;191:1124–9.

    Article  PubMed  Google Scholar 

  • Bertholf ME, Stafford MJ. Colonization of Candida albicans in vagina, rectum, and mouth. J Fam Pract. 1983;16:919.

    CAS  PubMed  Google Scholar 

  • Carey JC, Klebanoff MA, Hauth JC, Hillier SL, Thom EA, Ernest JM, et al. Metronidazole to prevent preterm delivery in pregnant women with asymptomatic bacterial vaginosis. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. N Engl J Med. 2000;342:534–40.

    Article  CAS  PubMed  Google Scholar 

  • Cibley LJ, Cibley LJ. Cytolytic vaginosis. Am J Obstet Gynecol. 1991;165:1245–9.

    Article  CAS  PubMed  Google Scholar 

  • Farage M, Maibach HI. The vulvar epithelium differs from the skin: implications for cutaneous testing to address topical vulvar exposures. Contact Dermatitis. 2004;51:201.

    Article  PubMed  Google Scholar 

  • Fouts AC, Kraus SJ. Trichomonas vaginalis: reevaluation of its clinical presentation and laboratory diagnosis. J Infect Dis. 1980;141:137.

    Article  CAS  PubMed  Google Scholar 

  • Gravett MG, Hummel D, Eschenbach DA, Holmes KK. Preterm labor associated with subclinical amniotic infection and with bacterial vaginosis. Obstet Gynecol. 1986;67:229–37.

    Article  CAS  PubMed  Google Scholar 

  • Gutman RE, Peipert JF, Weitzen S, Blume J. Evaluation of clinical methods for diagnosing bacterial vaginosis. Obstet Gynecol. 2005;105:551–6.

    Article  PubMed  Google Scholar 

  • Hill GB. The microbiology of bacterial vaginosis. Am J Obstet Gynecol. 1993;169:450.

    Article  CAS  PubMed  Google Scholar 

  • Hillier SL, Nugent RP, Eschenbach DA, Krohn MA, Gibbs RS, Martin DH, et al. Association between bacterial vaginosis and preterm delivery of low-birth-weight infant. The Vaginal Infections and Prematurity Study Group. N Engl J Med. 1995;333:1737–42.

    Article  CAS  PubMed  Google Scholar 

  • Horowitz BJ, Giaquinta D, Ito S. Evolving pathogens in vulvovaginal candidiasis: implications for patient care. J Clin Pharmacol. 1992;32:248.

    Article  CAS  PubMed  Google Scholar 

  • Johnson NR, Scheinman PL, Watson AJ. “Vulvar dermatitis”. Vulvar dermatitis. Wolters Kluwer Health; 2016. Available from Web. 1 August 2016. http://www.uptodate.com/contents/vulvar-dermatitis

  • Klebanoff MA, Carey JC, Hauth JC, Hillier SL, Nugent RP, Thom EA, et al. Failure of metronidazole to prevent preterm delivery among pregnant women with asymptomatic Trichomonas vaginalis infection. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. N Engl J Med. 2001;345:487–93.

    Article  CAS  PubMed  Google Scholar 

  • Koumans EH, Kendrick JS. Preventing adverse sequelae of bacterial vaginosis: a public health program and research agenda. CDC Bacterial Vaginosis Working Group. Sex Transm Dis. 2001;28:292–7.

    Article  CAS  PubMed  Google Scholar 

  • Krieger JN, Tam MR, Stevens CE, et al. Diagnosis of trichomoniasis. Comparison of conventional wet-mount examination with cytologic studies, cultures, and monoclonal antibody staining of direct specimens. JAMA. 1988;259:1223.

    Article  CAS  PubMed  Google Scholar 

  • Lamont RF, Sobel JD, Akins RA, et al. The vaginal microbiome: new information about genital tract flora using molecular based techniques. BJOG. 2011;118:533.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ling Z, Kong J, Liu F, et al. Molecular analysis of the diversity of vaginal microbiota associated with bacterial vaginosis. BMC Genomics. 2010;11:488.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lynch PJ. Lichen simplex chronicus (atopic/neurodermatitis) of the anogenital region. Dermatol Ther. 2004;17:8.

    Article  PubMed  Google Scholar 

  • Marren P, Wojnarowska F. Dermatitis of the vulva. Semin Dermatol. 1996;15:36.

    Article  CAS  PubMed  Google Scholar 

  • Morales WJ, Schorr S, Albritton J. Effect of metronidazole in patients with preterm birth in preceding pregnancy and bacterial vaginosis: a placebo-controlled, double-blind study. Am J Obstet Gynecol. 1994;171:345–7; discussion 348–9.

    Google Scholar 

  • Nguyen Y, Lee A, Fischer G. Management of chronic vulvovaginal candidiasis: a long term retrospective study. Aust J Dermatol. 2016. doi:10.1111/ajd.12497

    Google Scholar 

  • Odds FC. Candidosis of the genitalia. In: Odds FC, editor. Candida and candidosis: a review and bibliography. 2nd ed. London: Bailliére Tindall; 1988. p. 124.

    Google Scholar 

  • Pandit L, Ouslander JG. Postmenopausal vaginal atrophy and atrophic vaginitis. Am J Med Sci. 1997;314:228.

    CAS  PubMed  Google Scholar 

  • Reichman O, Sobel J. Desquamative inflammatory vaginitis. Best Pract Res Clin Obstet Gynaecol. 2014;28:1042.

    Article  PubMed  Google Scholar 

  • Schmid G, Narcisi E, Mosure D, Secor WE, Higgins J, Moreno H. Prevalence of metronidazole-resistant Trichomonas vaginalis in a gynecology clinic. J Reprod Med. 2001;46:545–9.

    CAS  PubMed  Google Scholar 

  • Sewankambo N, Gray RH, Wawer MJ, Paxton L, McNaim D, Wabwire-Mangen F, et al. HIV-1 infection associated with abnormal vaginal flora morphology and bacterial vaginosis [published erratum appears in Lancet 1997;350:1036]. Lancet. 1997;350:546–50.

    Article  CAS  PubMed  Google Scholar 

  • Shaw C, Mason M, Scoular A. Group B streptococcus carriage and vulvovaginal symptoms: causal or casual? A case-control study in a GUM clinic population. Sex Transm Infect. 2003;79:246–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Sobel JD. Recurrent vulvovaginal candidiasis. A prospec-tive study of the efficacy of maintenance ketoconazole therapy. N Engl J Med 1986;315:1455–8.

    Article  CAS  PubMed  Google Scholar 

  • Sobel JD. Desquamative inflammatory vaginitis: a new subgroup of purulent vaginitis responsive to topical 2% clindamycin therapy. Am J Obstet Gynecol. 1994;171:1215–20.

    Article  CAS  PubMed  Google Scholar 

  • Sobel JD. Vaginitis. N Engl J Med. 1997;337:1896–903.

    Article  CAS  PubMed  Google Scholar 

  • Sobel JD. Vulvovaginitis in healthy women. Compr Ther. 1999;25:335.

    Article  CAS  PubMed  Google Scholar 

  • Sobel JD. Vulvovaginal candidosis. Lancet. 2007;369:1961.

    Article  PubMed  Google Scholar 

  • Sobel JD. “Approach to women with symptoms of vaginitis”. Approach to women with symptoms of vaginitis. Wolters Kluwer Health; 2016a, Available from web 2016a.Web. 19 August 2016, http://www.uptodate.com/contents/approach-to-women-with-symptoms-of-vaginitis

  • Sobel JD. “Bacterial Vaginosis”. Bacterial vaginosis. Wolters Kluwer health, 2016b. Avilable from Web. 12 October 2016, http://www.uptodate.com/contents/bacterial-vaginosis

  • Sobel JD. “Candida vulvovaginitis”. Candida vulvovaginitis. Wolters Kluwer Health; 2016c. Available from Web. 25 May 2016, http://www.uptodate.com/contents/candida-vulvovaginitis

  • Sobel, JD. “Desquamative inflammatory vaginitis”. Desquamative inflammatory vaginitis. Wolters Kluwer Health; 2016d. Available from web. 19 August 2016, http://www.uptodate.com/contents/desquamative-inflammatory-vaginitis

  • Sobel JD. “Trichomoniasis”. Trichomoniasis. Wolters Kluwer Health; 2016e. Available from web.16 Mar 2016, http://www.uptodate.com/contents/trichomoniasis

  • Sobel JD, Brooker D, Stein GE, Thomason JL, Wermeling DP, Bradley B, et al. Single oral dose fluconazole compared with conventional clotrimazole topical therapy of Candida vaginitis. Fluconazole Vaginitis Study Group. Am J Obstet Gynecol. 1995;172:1263–8.

    Article  CAS  PubMed  Google Scholar 

  • Sobel JD, Faro S, Force RW, et al. Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations. Am J Obstet Gynecol. 1998;178:203.

    Article  CAS  PubMed  Google Scholar 

  • Sobel JD, Kapernick PS, Zervos M, Reed BD, Hooton T, Soper D, et al. Treatment of complicated Candida vaginitis: comparison of single and sequential doses of fluconazole. Am J Obstet Gynecol. 2001;185:363–9.

    Article  CAS  PubMed  Google Scholar 

  • Sobel JD, Chaim W, Nagappan V, Leaman D. Treatment of vaginitis caused by Candida glabrata: use of topical boric acid and flucytosine. Am J Obstet Gynecol. 2003;189:1297–300.

    Article  CAS  PubMed  Google Scholar 

  • Sobel JD, Wiesenfeld HC, Martens M, et al. Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. N Engl J Med 2004; 351:876.

    Article  CAS  PubMed  Google Scholar 

  • Sobel JD, Reichman O, Misra D, Yoo W. Prognosis and treatment of desquamative inflammatory vaginitis. Obstet Gynecol. 2011;117:850.

    Article  PubMed  Google Scholar 

  • Sood G, Nyirjesy P, Weitz MV, Chatwani A. Terconazole cream for non Candida albicans fungal vaginitis: results of a retrospective analysis. Infect Dis Obstet Gynecol. 2000;8:240–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Spiryda LB, Laufer MR, Soiffer RJ, Antin JA. Graft-versus-host disease of the vulva and/or vagina: diagnosis and treatment. Biol Blood Marrow Transplant. 2003;9:760.

    Article  PubMed  Google Scholar 

  • Taha ET, Hoover DR, Dallabetta GA, Kumwedna NI, Mtimavalye LA, Yang LP, et al. Bacterial vaginosis and disturbances of vaginal flora: association with increased acquisition of HIV. AIDS. 1998;12:1699–706.

    Article  CAS  PubMed  Google Scholar 

  • Vermitsky JP, Self MJ, Chadwick SG, et al. Survey of vaginal-flora Candida species isolates from women of different age groups by use of species-specific PCR detection. J Clin Microbiol. 2008;46:1501.

    Article  PubMed  PubMed Central  Google Scholar 

  • Weinstock H, Berman S, Cates Jr W. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health. 2004;36:6–10.

    Article  PubMed  Google Scholar 

  • Wilson J. Managing recurrent bacterial vaginosis. Sex Transm Infect. 2004;80:8–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Workowski KA, Bolan GA. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep. 2015;64:1.

    Article  PubMed  Google Scholar 

  • Xu J, Sobel JD. Candida vulvovaginitis in pregnancy. Curr Infect Dis Rep. 2004;6:445–9.

    Article  PubMed  Google Scholar 

  • Yudin MH, Landers DV, Meyn L, Hillier SL. Clinical and cervical cytokine response to treatment with oral or vagi-nal metronidazole for bacterial vaginosis during preg-nancy: a randomized trial. Obstet Gynecol 2003;102:527–34.

    CAS  PubMed  Google Scholar 

  • Zantomio D, Grigg AP, MacGregor L, et al. Female genital tract graft-versus-host disease: incidence, risk factors and recommendations for management. Bone Marrow Transplant. 2006;38:567.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. UCLA Medical Center, University of California, Los Angeles, CA, USA

    Mya Rose Zapata

Authors
  1. Mya Rose Zapata
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mya Rose Zapata .

Editor information

Editors and Affiliations

  1. Department of Obstetrics and Gynecology and Family Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA

    Donna Shoupe

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this entry

Cite this entry

Zapata, M.R. (2017). Diagnosis and Treatment of Vulvovaginitis. In: Shoupe, D. (eds) Handbook of Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-319-17002-2_25-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-17002-2_25-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-17002-2

  • Online ISBN: 978-3-319-17002-2

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation