Diagnosis and management of infectious vaginitis

Vaginitis is an important gynecologic disorder that accounts for nearly 5 million office visits to physicians each year. Infectious vaginitis is the most common cause for an abnormal vaginal discharge; other possible causes include cervicitis, atrophic vaginitis, physiologic discharge, physicochemical vaginitis, and psychosomatic vaginitis. Although the history and physical examination may suggest the diagnosis, laboratory confirmation is required. The vaginal pool wet mount remains the cornerstone in the office diagnosis of vaginitis, with the "sniff" test, vaginal pH determination, and the "swab" test all playing important adjunctive roles. Metronidazole is the only effective treatment for trichomoniasis in the United States. The vaginal administration of an imidazole antifungal agent is the mainstay of treatment of vaginal candidiasis. Despite a search for alternative drug regimens, a 7-day course of metronidazole therapy remains the treatment of choice for bacterial vaginosis.