Vaginitis - Diagnosis

Clinical diagnosis is based on the symptoms and a pelvic examination

During the pelvic exam a speculum is introduced into the vagina for direct visualization of the cervix. The following features are noted:

The amount, nature, color and odor of the discharge is noted.
The vaginal mucosa is observed for any bleeding, atrophy and reddening,
Yeast infection reveals thrush-like patches and scratch marks on the mucous membrane of the vagina
In trichomoniasis a thin, greenish yellow, bubbly discharge is seen and the mucous membrane has a reddened strawberry-like appearance.

The discharge is collected and the following tests are done to aid in the diagnosis.

Saline wet - mount preparation

A wet preparation of the discharge is made on glass slide and observed under a microscope to make the following evaluations:

Presence of budding yeasts or pseudo hyphae is suggestive of Yeast Infection.
Presence of clue cells is suggestive of bacterial vaginosis
Presence of trichomonads is suggestive of trichomoniasis.

Potassium hydroxide (KOH) preparation - The vaginal discharge is mixed with a solution of potassium hydroxide (KOH). The presence of yeast hyphae and spores indicate a yeast infection.

Vaginal pH - The normal vaginal pH is 3.8 to 4.5. pH more than 4.5 is suggestive of Bacterial Vaginosis (BV), trichomoniasis, or atrophic vaginitis.

Whiff test - The vaginal discharge is mixed with potassium hydroxide (KOH) solution and the odor observed. A b fishy odor is suggestive of Bacterial Vaginosis (BV).