Vulvovaginitis Disease

DESCRIPTION

Infectious disease affecting the vagina, only rarely affecting the vulva

System(s) affected: Reproductive
Genetics: N/A
Incidence/Prevalence in USA: As low as 4% in unselected populations; up to 33% in STD clinics; up to 44% in patients with vaginitis
Predominant age: N/A
Predominant sex: Female

SIGNS AND SYMPTOMS

Unpleasant vaginal odor, musty or fishy, exacerbated immediately after intercourse
Thin gray-white vaginal discharge, mildly adherent to vaginal walls
10-30% with vaginal/vulvar irritation
10% with frothy discharge

CAUSES

Polymicrobial; Gardnerella vaginalis, Mobiluncus species, Mycoplasma hominis, Peptostreptococcus, other various anaerobes, including Prevotella, Bacteroides, and Fusobacterium
There is a shift from a healthy lactobacilli based endogenous flora to an anaerobically based endogenous flora
Rectal reservoir of organisms leading to autoinfection

RISK FACTORS

Controversial regarding multiple sexual partners
IUD

LABORATORY

Affirm VP microprobe
PH paper (pH > 4.5)
Wet prep - clue cells in > 10-20% of epithelial cells, fewer WBC's than epithelial cells
10% KOH - "whiff test" transient amine or fishy odor
Gram stain indicating absence of lactobacilli
May be seen on cytology
Culture difficult for mycoplasma, not useful

Drugs that may alter lab results: Recent douching
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Biopsies demonstrate no histologic evidence of inflammation

SPECIAL TESTS

N/A

IMAGING

N/A

DIAGNOSTIC PROCEDURES

N/A

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Consider repletion of lactobacilli

SURGICAL MEASURES

N/A

ACTIVITY

No restrictions

DIET

No restrictions

PATIENT EDUCATION

N/A

PREVENTION/AVOIDANCE

Good hygiene
Use of condoms for sexual intercourse

POSSIBLE COMPLICATIONS

Uncommon but include
- Adnexal tenderness
- PID
- Intrauterine infections
- Chorioamnionitis
- Post abortion PID
- Postpartum endometritis
- Pelvic abscesses
- Vaginitis emphysematous
- Rare extravaginal disease
- Pre-term labor
- Premature rupture of membranes
- Chorioamnionitis
- Newborn infections, including scalp electrode sites, abscesses, and 1 reported case of meningitis
- Fetal loss
Post-hysterectomy infection, septicemia, gaseous crepitation in wound

EXPECTED COURSE AND PROGNOSIS

Relapses fairly common, can be decreased by increased colonization of lactobacilli

ASSOCIATED CONDITIONS

N/A

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: N/A
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.