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Vulvovaginitis - Causes, Sign & Symptoms And Treatment of Vulvovaginitis

Alternative names :- Vaginal inflammation; Inflammation of the vagina.

Inflammation of the vulva (vulvitis) and 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 and 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 Trichomonas vaginalis, a protozoan flagellate, usually transmitted through sexual intercourse.
• infection with Candida albicans (Monilia), a fungus that requires glucose for growth. Incidence rises during the secretory phase of the menstrual cycle. Such infection occurs twice as often in pregnant females as in non pregnant females. It also commonly affects users of oral contraceptives, diabetics, and patients receiving systemic therapy with broad-spectrum antibiotics (incidence may reach 75%).
• infection with Gardnerella vaginitis, a gram-negative bacillus.
• venereal infection with Neisseria gonorrhoeae (gonorrhea), a gram-negative diplococcus.
• viral infection with venereal 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 (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 of vulvovaginitis

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.

• Monilia 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.
• Hemophilus vaginitis produces a gray, foul-smelling discharge.
• Gonorrhea may produce no symptoms at all, or a profuse, purulent discharge and dysuria.
• 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.
• 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, and 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 venereal disease may require complete blood count, urinalysis, cytology screening, biopsy of chronic lesions to rule out malignancy, and culture of exudate from acute lesions

Vulvovaginitis treatment

Common therapeutic measures include the following:

• oral metronidazole for the patient with trichomonal vaginitis and for all sexual partners
• topical miconazole 2% or clotrimazole 1 % for candidal infection
• metronidazole for Gardnerella
• systemic antibiotic therapy for the patient with gonorrhea and for all sexual partners
• doxycycline or erythromycin for 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, and applying topical corti costeroids 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 currently exists for herpesvirus infections; however, oral and topical acyclovir (Zovirax) decreases the duration and symptoms of active lesions.

Special considerations

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

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