Vulvovaginitis
Vulvovaginitis: Excerpt from Professional Guide to Diseases (Eighth Edition)
Vulvovaginitis is inflammation of the vulva (vulvitis) and vagina (vaginitis). Because of the proximity of these two structures, inflammation of one occasionally causes inflammation of the other. Vulvovaginitis may occur at any age and affects most females at some time. The prognosis is excellent with treatment.
Causes and incidence
Common causes include:
❑ infection with Trichomonas vaginalis, a protozoan flagellate usually transmitted through sexual intercourse
❑ infection with Candida albicans, a fungus that requires glucose for growth. Incidence rises during the menstrual cycle’s secretory phase (Such infection occurs twice as often in pregnant females as in nonpregnant females. It also commonly affects users of hormonal contraceptives, patients who are diabetic, and patients receiving systemic therapy with broad-spectrum antibiotics [incidence may reach 75%.])
❑ infection with Gardnerella vaginalis, a gram-negative bacillus
❑ 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. Candidal 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. G. vaginalis produces a gray, foul, “fishy” smelling discharge.
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.
Diagnosis
Diagnosis of vulvovaginitis requires 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 some cases, a culture of the vaginal discharge may identify the organism causing the infection.
Diagnosis of vulvitis or suspected venereal disease may require complete blood count, urinalysis, cytology screening, biopsy of chronic lesions to rule out malignancy, culture of exudate from acute lesions, and possible human immunodeficiency virus testing.
Treatment
The cause of vulvovaginitis determines the appropriate treatment. It may include oral or topical antibiotics, antifungal creams, antibacterial creams, or similar medications. An antihistamine may be prescribed for allergic reactions. 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 herpes-virus infections; however, oral and topical acyclovir decreases the duration and symptoms of active lesions.
If a sexually transmitted disease (STD) is diagnosed, it’s very important that partners also receive treatment, even if there are no symptoms. Failure of partners to receive treatment can lead to continual reinfection, which may eventually lead to infertility and affect the patient’s overall health.
Special considerations
❑ Ask the patient if she has any drug allergies. Stress the importance of taking the medication for the length of time prescribed, even if symptoms subside.
❑ Teach the patient how to insert vaginal ointments and suppositories. Tell her to remain prone for at least 30 minutes after insertion to promote absorption (insertion at bedtime is ideal). Suggest she wear a pad to prevent staining her underclothing.
❑ Encourage good hygiene. Advise the patient with a history of recurrent vulvovaginitis to wear all-cotton underpants. Advise her to avoid wearing tight-fitting pants and panty hose, which encourage the growth of the infecting organisms. Removing underpants at night is also helpful.
❑ Report notifiable cases of STDs to local public health authorities.
❑ Tell the patient that persistent, recurring candidiasis may suggest diabetes or undiagnosed pregnancy.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Dysmenorrhea (Professional Guide to Signs & Symptoms (Fifth Edition))
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