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Common Types of Vaginitis

Disorder

Typical Symptoms and Signs

Criteria for Diagnosis

Microscopic Findings

Differential Diagnosis

Bacterial vaginosis

Yellow-green or gray, thin, fishy-smelling discharge; no dyspareunia

Uncommonly, pruritus and irritation

Three of the following (Amsel criteria):

  • Yellow-green or gray discharge

  • pH > 4.5

  • Fishy odor

  • Clue cells detected by microscopy

Saline wet mount*: Clue cells, decreased lactobacilli, increased coccobacilli

Trichomonal vaginitis

Candidal vaginitis

Thick, white discharge; vaginal and sometimes vulvar pruritus with or without burning, irritation, or dyspareunia

Typical discharge, pH < 4.5, and microscopic findings

Culture if clinical suspicion is high and microscopic findings are negative or symptoms recur or persist after treatment

Potassium hydroxide wet mount†: Budding yeast, pseudohyphae, or mycelia

Contact irritant or allergic vulvitis

Vulvodynia

Trichomonal vaginitis

Profuse, malodorous, yellow-green discharge; dysuria; dyspareunia; erythema

NAAT

  1. OR

Identification of causative organism by microscopy

Culture if NAAT or microscopy is not available

Saline wet mount*: Motile, flagellated protozoa, increased PMNs

Bacterial vaginosis

Inflammatory vaginitis

Inflammatory vaginitis

Purulent discharge, vaginal dryness and thinning, dyspareunia, dysuria; usually in postmenopausal women

pH > 6, negative whiff test, and characteristic microscopy findings

Increased PMNs, parabasal cells, and cocci; decreased bacilli

Erosive lichen planus

* Saline wet mount slide is prepared with 0.9% sodium chloride.* Saline wet mount slide is prepared with 0.9% sodium chloride.

† Potassium hydroxide wet mount slide is prepared with 10% potassium hydroxide solution.

NAAT = nucleic acid amplification test; PMN = polymorphonuclear leukocyte.

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