1776 1777 1778 ## Key Points 1779 1780 Douching is not helpful for prevention or treatment of vaginitis. 1781 Signs and symptoms of vaginitis are not specific, but a cause can usually be diagnosed on office microscopy. 1782 Speculum examination is not necessary for diagnosis of vaginitis; a blind swab in the vaginal vault is equally sensitive. 1783 Self-diagnosis of vaginal infection by the patient is unreliable. 1784 1785 1786 1787 *Table 25-7 Comparison of Findings for Vaginitis* 1788 1789 1790

Type	Symptoms	Signs	pH	KOH	Saline Wet Mount
Bacterial vaginosis	Malodorous discharge	Thin, gray adherent discharge	>4.5	Amine or fishy odor	Clue cells
Vulvovaginal candidiasis	Itching, burning pain	Curdlike discharge, vulvar erythema	3.8-4.5	Pseudohyphae; budding yeast	Occasional hyphae; yeast
Trichomoniasis	Fish-odor discharge	Erythema, tenderness	6-7	Negative	Trichomonads, many WBCs
Atrophic vaginitis	Dryness, pain	Pale, friable	>4.5	Negative	RBCs, WBCs; many bacteria
Aerobic vaginitis	Foul odor	Heavy purulent discharge	>4.5	Negative	Cocci or coarse rods
Irritant or allergic vaginitis	Itching, swelling	Erythema	Any	Negative	Negative

1791 1792 *KOH, Potassium hydroxide; RBCs, red blood cells; WBCs, white blood cells.* 1793 1794 *Table 25-8 Differential Diagnosis of Vaginal* 1795 1796 *Discharge: Vaginitis* 1797 1798 Candida spp. (Candida albicans, Candida glabrata) 1799 1800 Bacterial vaginosis (anaerobic bacteria: Gardnerella vaginalis, 1801 1802 Bacteroides sp 1803 1804 Desquamative inflammatory vaginitis: aerobic bacteria 1805 1806 Trichomonas vaginalis 1807 1808 Allergic vaginitis or contact dermatitis 1809 1810 Chlamydial infection or gonorrhea 1811 1812 Erosive lichen planus vaginitis 1813 1814 Actinomyces Behçet syndrome (associated with IUC use) 1815 1816 Vulvar vestibulitis 1817 1818 Physiologic (leukorrhea) 1819 1820 Atrophic vaginitis 1821 1822 *IUC, Intrauterine contraception.* 1823 1824 Vaginitis is the most common gynecologic diagnosis made in the primary care setting. Common symptoms include increased vaginal discharge without pelvic pain or systemic symptoms, vulvar itching and burning, dysuria, and pos- sible odor. Physiologic leukorrhea varies and may change with a woman [... Output truncated due to length. 663 tokens/2555 characters removed ...]