Diagnostic studies

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A. Vaginal pH. Measurement of vaginal pH should always be determined. The pH of the normal vaginal secretions is 4.0 to 4.5. A pH above 4.5 suggests bacterial vaginosis or trichomoniasis (pH 5 to 6), and helps to exclude candida vulvovaginitis (pH 4 to 4.5).

B. Saline microscopy should look for candidal buds or hyphae, motile trichomonads, epithelial cells studded with adherent coccobacilli (clue cells), and polymorphonuclear cells (PMNs). The addition of 10% potassium hydroxide to the wet mount is helpful in diagnosing candida vaginitis. Culture for candida and trichomonas may be useful if microscopy is negative.

C. Cervical culture. A diagnosis of cervicitis, typically due to Neisseria gonorrhoeae or Chlamydia trachomatis, must always be considered in women with purulent vaginal discharge. The presence of high-risk behavior or any sexually transmitted disease requires screening for HIV, hepatitis B, and other STDs.

Clinical Manifestations of Vaginitis

Candidal Vagi-nitis

Nonmalodorous, thick, white, "cottage cheese-like" discharge that adheres to vaginal walls

Hyphal forms or budding yeast cells on wet-



Normal pH (<4.5)

Bacterial VaginosisBact erial Vaginosis

Thin, dark or dull grey, homogeneous, malodorous discharge that adheres to the vaginal walls

Elevated pH level (>4.5) Positive KOH (whiff test) Clue cells on wet-mount microscopic evaluation

Trichomonas VaginalisTrich omonas Vaginalis

Copious, yellow-gray or green, homogeneous or frothy, malodorous discharge Elevated pH level (>4.5) Mobile, flagellated organisms and leukocytes on wet-mount microscopic evaluation Vulvovaginal irritation, dysuria

Atrophic Vaginitis

Vaginal dryness or burning

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Bacterial Vaginosis Facts

Bacterial Vaginosis Facts

This fact sheet is designed to provide you with information on Bacterial Vaginosis. Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.

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