Importance of differential diagnosis in acute vaginitis

Acute vaginitis is one of the most common diseases seen in the practice of office gynecology. Large survey studies of women with lower genital tract symptoms suggestive of vaginitis have demonstrated the presence of three major etiologic categories in acute vaginitis: (1) nonspecific vaginosis (Gardnerella vaginalis), (2) vulvovaginal candidiasis (Candida albicans), and (3) trichomoniasis (Trichomonas vaginalis). Effective treatment of acute vaginitis requires that an accurate diagnosis be established and etiologic microorganism(s) be identified. In general, the differential diagnosis of acute vaginitis does not rely on elaborate technology but, rather, requires inexpensive and readily available office equipment and supplies, a detailed history, and an adequate examination of the external genitalia, vagina, and cervix. Only after the etiology of vaginitis has been identified can appropriate therapeutic intervention(s) be utilized.