Common Types of Vaginitis
Disorder | Typical Symptoms | Diagnostic Methods | Microscopic Findings | Differential Diagnosis |
|---|---|---|---|---|
Discharge is white-gray or green, thin, homogeneous, smoothly coats the vaginal walls, and malodorous (fishy-smelling) Sometimes mild vulvovaginal irritation Often asymptomatic | Amsel criteria (at least 3 of 4 of the following):
NAAT DNA hybridization probe | Saline wet mount*: > 20% of vaginal epithelial cells are clue cells (vaginal epithelial cells with adherent coccobacilli); increased coccobacilli; decreased lactobacilli | Trichomonal vaginitis | |
White, thick discharge, sometimes clumpy or curd-like Vaginal and sometimes vulvar pruritus, burning or irritation, or dyspareunia | Typical discharge and symptoms, pH < 4.5, and microscopy NAAT DNA hybridization probe Culture (gold standard) if clinical suspicion is high and microscopic findings are negative or symptoms recur or persist after treatment | 10% Potassium hydroxide wet mount†: Budding yeast, pseudohyphae, or hyphae | Contact irritant or allergic vulvitis Vulvodynia | |
Yellow-green thin, malodorous, profuse discharge Burning, irritation, sometimes dysuria, dyspareunia, or postcoital bleeding | pH usually > 4.5, negative whiff test, and detection of trichomonads by microscopy NAAT (gold standard) DNA hybridization probe Rapid antigen test Culture if microscopy or molecular diagnostic tests are not available | Saline wet mount*: Motile trichomonads (flagellated protozoa), increased PMNs | Bacterial vaginosis Desquamative inflammatory vaginitis | |
Copious discharge Vaginal pain, burning, dyspareunia Most common in perimenopausal and postmenopausal women | pH > 4.5, negative whiff test, and characteristic microscopy findings | Saline wet mount*: Increased PMNs, parabasal cells; decreased lactobacilli | Erosive lichen planus | |
Hypoestrogenic (atrophic) vaginitis | White, yellow, or brown, scant, watery, sometimes malodorous discharge Vaginal dryness, irritation, burning; dyspareunia; postcoital bleeding; sometimes vulvar fissures Occurs in patients in menopause or with other causes of hypoestrogenism (ie, antiestrogenic medications) | pH > 4.5, negative whiff test | Saline wet mount*: Decreased lactobacilli; increased PMNs; parabasal cells (immature vaginal epithelial cells with relatively large nuclei) | Desquamative inflammatory vaginitis Erosive lichen planus |
* Saline wet mount slide is prepared with 0.9% sodium chloride. | ||||
† Potassium hydroxide wet mount slide is prepared with 10% potassium hydroxide solution. | ||||
NAAT = nucleic acid amplification test; PMN = polymorphonuclear leukocyte. Reference: Vaginitis in Nonpregnant Patients: ACOG Practice Bulletin, Number 215. Obstet Gynecol. 2020;135(1):e1-e17. doi:10.1097/AOG.0000000000003604 | ||||