Vaginitis: a common malady

Approximately 90 per cent of all the vaginitides are caused by bacterial vaginosis, candidiasis, or trichomoniasis. Bacterial vaginosis is the most frequent, causing approximately 50 per cent of vaginal infections. As described by Amsel and colleagues, three of four findings indicate bacterial vaginosis: amine odor, pH greater than 4.5, clue cells, and a thin homogeneous discharge. Because G. vaginalis colonizes the vagina, treatment should not be instituted in an asymptomatic woman on the basis of a positive culture. For symptomatic patients, oral metronidazole 500 mg twice daily for 7 days is the treatment currently recommended. Vulvovaginal pruritus should be equated with candidiasis until proven otherwise. Mycelia or spores on 10 per cent KOH preparation are diagnostic of candidiasis in the presence of symptoms. Imidazole creams or suppositories are the treatment of choice. Trichomoniasis is characterized by malodor and mild pruritus. Demonstration of trichomonads on saline preparation or a positive culture provides the diagnosis. A single 2 gm dose of oral metronidazole is the initial treatment. Recurrences should provoke inquiry regarding predisposing factors and investigation of sexual partners. Vaginitis can recur, but if approached properly, these recurrences can be minimized, allowing the patient to proceed with daily life in comfort.