Clinical Features of Vaginitis
Variable Normal Vulvovaginal Bacterial Trichomoniasis candidiasis vaginosis
Sympotoms Normal or Pruritis, soreness Malodorous Malodorous, purulent mild transient change in dis- discharge, no discharge, dyspareunia charge, dyspa- dyspareunia reunia Signs - Vulvar erythema, Adherent Purulent discharge edema, fissure discharge vulvovaginal erythema
pH 4.0-4.5 4.0-4.5 >4.5 5.0-6.0
Saline PMN:EC PMN:EC ratio PMN:EC <1; loss PMN++++; mixed microscopy ratio <1; <1; rods dominate; of rods; increased flora; motile rods dominate; squames +++; coccobacilli; clue trichomonads
(60 squames pseudohyphase cells (>90 per percent) +++ (about 40 percent) cent)
10 percent Negative Pseudohyphae Negative Negative potassium (about 70 percent) hydroxide examination
Miscellaneous - Culture if micro- Culture of no value Culture if micros scopy negative copy negative
Differential Physiologic Contact irritant Purulent vaginitis, diagnosis leukorrhea or allergic vulvitis desquamative chemical irritation, inflammatory focal vulvitis vaginitis, atrophic (vulvodynia) vaginitis plus secondary infection, erosive lichen planus
Characteristic of vaginal discharge
The appearance of the discharge is unreliable and should never form the basis for diagnosis.
Cervical inflammation is suggestive of cervicitis rather than vaginitis. The cervix in women with cervicitis is usually erythematous and friable. Cervical erythema in this condition must be distinguished from ectropion, which represents the normal physiologic presence of endocervical glandular tissue on the exocervix. Ectropion is not friable and is more common in women taking oral contraceptives. Abdominal or cervical motion tenderness is suggestive of PID.
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