Vulvovaginitis
Vulvovaginitis: Excerpt from Handbook of Diseases
Inflammation of the vulva (vulvitis) and vagina (vaginitis) is called vulvovaginitis. Because of the proximity of these two structures, inflammation of one usually precipitates inflammation of the other. Vulvovaginitis may occur at any age and affects most females at some time. Prognosis is good with treatment.
Causes
Common causes of vaginitis (with or without consequent vulvitis) include:
❑ infection with Trichomonas vaginalis, a protozoan flagellate, usually transmitted through sexual intercourse
❑ infection with Candida albicans (Monilia), a fungus that requires glucose for growth (Incidence rises during the secretory phase of the menstrual cycle. Such infection occurs twice as often in pregnant females as in nonpregnant females. It also commonly affects users of hormonal contraceptives, diabetics, and patients receiving systemic therapy with broad-spectrum antibiotics [incidence may reach 75%].)
❑ infection with Gardnerella vaginitis, a gram-negative bacillus
❑ venereal infection with Neisseria gonorrhoeae (gonorrhea), a gram-negative diplococcus
❑ viral infection with venereal warts (condylomata acuminata) or herpes-virus Type II, usually transmitted by sexual intercourse
❑ vaginal mucosa atrophy in meno-pausal women due to decreasing levels of estrogen, which predisposes to bacterial invasion.
Common causes of vulvitis include:
❑ parasitic infection (Phthirus pubis [crab louse])
❑ trauma (skin breakdown may lead to secondary infection)
❑ poor personal hygiene
❑ chemical irritations, or allergic reactions to hygiene sprays, douches, detergents, clothing, or toilet paper
❑ vulval atrophy in menopausal women due to decreasing estrogen levels
❑ retention of a foreign body, such as a tampon or diaphragm.
Signs and symptoms
❑ In trichomonal vaginitis, vaginal discharge is thin, bubbly, green-tinged, and malodorous. This infection causes marked irritation and itching, and urinary symptoms, such as burning and frequency.
❑ Monilia vaginitis produces a thick, white, cottage-cheese-like discharge and red, edematous mucous membranes, with white flecks adhering to the vaginal wall, and is often accompanied by intense itching.
❑ Hemophilus vaginitis produces a gray, foul-smelling discharge.
❑ Gonorrhea may produce no symptoms at all, or a profuse, purulent discharge and dysuria.
❑ Acute vulvitis causes a mild to severe inflammatory reaction, including edema, erythema, burning, and pruritus. Severe pain on urination and dyspareunia may necessitate immediate treatment.
❑ Herpes infection may cause painful ulceration or vesicle formation during the active phase.
❑ Chronic vulvitis generally causes relatively mild inflammation, possibly associated with severe edema that may involve the entire perineum.
Diagnosis
Vaginitis is diagnosed by identification of the infectious organism during microscopic examination of vaginal exudate on a wet slide preparation (a drop of vaginal exudate placed in normal saline solution).
❑ In trichomonal infections, the presence of motile, flagellated trichomonads confirms the diagnosis.
❑ In monilia vaginitis, 10% potassium hydroxide is added to the slide, and microscopic examination seeks “clue cells” (granular epithelial cells); however, diagnosis requires identification of C. albicans fungi.
❑ Gonorrhea necessitates culture of vaginal exudate on Thayer-Martin or Transgrow medium to confirm diagnosis.
Diagnosis of vulvitis or suspected venereal disease may require complete blood count, urinalysis, cytology screening, biopsy of chronic lesions to rule out malignancy, and culture of exudate from acute lesions.
Treatment
Common therapeutic measures include the following:
❑ oral metronidazole for the patient with trichomonal vaginitis and for all sexual partners
❑ topical miconazole 2% or clotrimazole 1% for candidal infection
❑ metronidazole for Gardnerella
❑ systemic antibiotic therapy for the patient with gonorrhea and for all sexual partners
❑ doxycycline or erythromycin for chlamydial infection
❑ topical estrogen cream, which may be helpful for patients who have irritation and inflammation caused by a low estrogen level (post-menopausal).
Cold compresses or cool sitz baths may provide relief from pruritus in acute vulvitis; severe inflammation may require warm compresses. Other therapy includes avoiding drying soaps, wearing loose clothing to promote air circulation, and applying topical corticosteroids to reduce inflammation.
Chronic vulvitis may respond to topical hydrocortisone or antipruritics and good hygiene (especially in elderly or incontinent patients). Topical estrogen ointments may be used to treat atrophic vulvovaginitis.
No cure exists for herpesvirus infections; however, oral and topical acyclovir decreases the duration and symptoms of active lesions.
Special considerations
❑ Ask the patient if she has any drug allergies.
❑ Stress to the patient the importance of taking the medication for the length of time prescribed, even if symptoms subside.
❑ Instruct the patient on proper perineal hygiene to help healing and to prevent reinfection.
❑ Instruct the patient on sitz baths to promote comfort.
❑ Encourage the patient to allow more air to reach the genital area; this may be promoted by using cotton underwear or underwear that has a cotton lining in the crotch, which allows greater airflow and decreases the amount of moisture in the area. Tell the patient that removing underwear at bedtime may also help.
❑ Tell the patient to avoid nylon pantyhose and undergarments.
❑ If a sexually transmitted disease is diagnosed, tell the patient that her partner needs to be treated. Let the patient know that if her partner refuses to seek treatment, continual reinfection can result in extensive health problems, including fertility issues.
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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