Vaginitis

DESCRIPTION

Vaginitis typically presents with symptoms of vaginal discharge, odor, burning, and itching.
- May be due to infections including trichomoniasis, candidiasis, or bacterial vaginosis (BV)
- Noninfectious causes include foreign body or exposure to an irritant or allergen.
Vulvovaginitis is irritation or inflammation of both the vulva and the vagina; most often due to Candida albicans.
Cervicitis is inflammation of the uterine cervix; symptoms can include purulent vaginal discharge and vulvovaginal irritation.
- Most often due to sexually transmitted infections (STIs): Neisseria gonorrhoeae and Chlamydia trachomatis
- Less common infectious etiologies include herpes simplex virus (HSV), Trichomonas vaginalis, Mycoplasma genitalium, BV, and group A streptococci.
Physiologic leukorrhea (i.e., “physiologic discharge”) is vaginal fluid associated with pubertal onset and frequently precedes menarche. Its thickness, volume, and color vary throughout the menstrual cycle.

Approximately 75% of females have had at least one episode of vaginitis due to candidiasis in their lifetime.
In prepubescent females, 25–75% of vaginitis is nonspecific in etiology.
In postpubertal females, the most common causes of vaginitis are as follows:
- BV (22–50%)
- Vulvovaginal candidiasis (17–39%)
- T. vaginalis (4–35%)

Chemical or allergic irritants
- Latex condom allergies
- Perfumes, sprays, powders
Systemic causes
- Antibiotic use
- Diabetes mellitus
Trauma
- Foreign body or material
- Sexual abuse
- Mechanical irritation
Infectious causes
- Most common organisms in prepubertal females:
  - Haemophilus influenzae
  - Shigella
  - Pinworms or scabies
  - Streptococcus, Escherichia coli, and Staphylococcus caused by fecal material secondary to poor hygiene (i.e., wiping from back to front)
- Most common organisms in postpubertal females:
  - BV organisms include G. vaginalis; Mycoplasma hominis; and anaerobes such as Prevotella, Bacteroides, and Mobiluncus species.
  - C. albicans
  - T. vaginalis
  - STIs such as N. gonorrhoeae, C. trachomatis, and M. genitalium

In general, irritant risk factors often include soaps, tampons, topical products and medications, extreme cleansing, tight clothing, and douching.
For prepubertal females, poor hygiene is a common risk factor.
For postpubertal females
- BV:
  - Vaginal douching
  - Smoking
  - Intrauterine device usage
  - Prior pregnancy
  - Unprotected sexual intercourse
  - Use of spermicide
  - Multiple or new sexual partners
- Trichomoniasis:
  - Multiple or new sexual partners
  - Other STIs
  - Lack of condom use
  - Smoking
- Vulvovaginal candidiasis:
  - Use of systemic antibiotics
  - Uncontrolled diabetes mellitus
  - Diet high in refined sugars

In prepubertal females, the vagina has a neutral pH and atrophic mucosa.
In postpubertal females, the vagina has an acidic pH (3.8 to 5) due to the lactic acid and hydrogen peroxide production by vaginal flora Lactobacillus species, resulting in bactericidal activity.
Normal vaginal fluid volume and consistency changes with varying estrogen levels throughout the menstrual cycle, peaking in volume and thinness during ovulation.
Imbalances in the vaginal pH, vaginal fluid, and ecosystem result in the overgrowth of other microorganisms including candidiasis and bacteria.
In both prepubertal and postpubertal females, warm environment, antibiotics, and poor elimination hygiene result in overgrowth.
Unprotected vaginal penetration during intercourse can alter the vaginal pH.
Alkaline semen disrupts the lactobacillus environment.
Gardnerella vaginalis is known to adhere to the vaginal epithelium and form a biofilm that serves as scaffolding for the adherence of other organisms.