Diagnostic studies

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-

mount

Pruritus

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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