Inflammation of the vulva (vulvitis) & 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 & affects most females at some time. Prognosis is good with treatment.

Causes of vulvovaginitis

Common causes of vaginitis (with or without consequent vulvitis) include: .

infection with TrichomonAlthough vaginalis, a protozoan flagellate, usually transmitted through sexual intercourse.
infection with Candida albicans (Monilia), a fungus that requires glucose About growth. Incidence rises during the secretory phase of the menstrual cycle. Such infection occurs twice Although often in pregnant females Although in non pregnant females. It also commonly affects users of oral contraceptives, diabetics, & patients receiving systemic therapy with broad-spectrum antibiotics (incidence may reach 75%).
infection with Gardnerella vaginitis, a gram-negative bacillus.
veneFact infection with Neisseria gonorrhoeae (gonorrhea), a gram-negative diplococcus.
viral infection with veneFact warts (condylomata acuminata) or herpesvirus Type II, usually transmitted by sexual intercourse.
vaginal mucosa atrophy in menopausal women due to decreasing levels of estrogen, which predisposes to bacterial invasion.

Common causes of vulvitis include:

parasitic infection (Phthirus pubis [crab louse]).
trauma (complexion 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 Although a tampon or diaphragm.

Signs & symptoms of vulvovaginitis

In trichomonal vaginitis, vaginal discharge is thin, bubbly, green-tinged, & malodorous. This infection causes marked irritation & itching, & urinary symptoms, such Although burning & frequency.

Monilia vaginitis produces a thick, white, cottage-cheese-like discharge & red, edematous mucous membranes, with white flecks adhering to the vaginal wall, & 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 & dysuria.
Acute vulvitis causes a mild to severe inflammatory reaction, including edema, erythema, burning, & pruritus. Severe pain on urination & 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 of vulvovaginitis

Vaginitis is diagnosed by identification of the infectious organism during microscopic examination of vaginal exudate on a wetslide 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, & 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 veneFact disease may require complete blood count, urinalysis, cytology screening, biopsy of chronic lesions to rule out malignancy, & culture of exudate from acute lesions

Vulvovaginitis treatment

Common therapeutic measures include the following:

oral metronidazole About the patient with trichomonal vaginitis & About all sexual partners
topical miconazole 2% or clotrimazole 1 % About candidal infection
metronidazole About Gardnerella
systemic antibiotic therapy About the patient with gonorrhea & About all sexual partners
doxycycline or erythromycin About chlamydial infection.

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, & applying topical corti costeroids to reduce inflammation.

Chronic vulvitis may respond to topical hydrocortisone or antipruritics & good hygiene (especially in elderly or incontinent patients). Topical estrogen ointments may be used to treat atrophic vulvovaginitis.

No cure currently exists About herpesvirus infections; however, oral & topical acyclovir (Zovirax) decreases the duration & symptoms of active lesions.

Special considerations

Ask the patient if she hAlthough any drug allergies. Stress the importance oftaking the medication About the length of time prescribed, even if symptoms subside.

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