A patient presents with vaginal inflammation with discharge, pain and/or itching. Next steps should include
Perform “whiff test” with 10% KOH, and microscopy with saline
Determine vaginal pH
If pH is normal (<4.7) consider the following
If pH is elevated (>4.7) consider the following
Vaginitis is a general term for disorders of the vagina, but does not indicate the underlying cause. Vaginitis may result from infection, inflammation, or may reflect changes in the normal vaginal microbiome. The disorder is termed vulvovaginosis when the vulva is involved. When patients present with symptoms of itching/burning/irritation/dyspareunia/discharge consider a broad range of possibilities including but not limited to the triad of bacterial vaginosis (BV), trichomoniasis and vulvovaginal candidiasis. Office based tests such as those above also have a low sensitivity. Accurate diagnosis may require a combination of a careful history, vulvar or vaginal biopsy and appropriate culture.
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