Update on vaginal infections: Aerobic vaginitis and other vaginal abnormalities / Actualización en infecciones vaginales: vaginitis aeróbica y otras alteraciones vaginales

It is estimated that abnormal vaginal discharge cannot be attributed to a clear infectious etiology in 15% to 50% of cases. Some women develop chronic vulvovaginal problems that are difficult to diagnose and treat, even by specialists. These disorders (aerobic vaginitis, desquamative inflammatory vaginitis, atrophic vaginitis, and cytolytic vaginosis) pose real challenges for clinical diagnosis and treatment. Researchers have established a diagnostic score based on phase-contrast microscopy. We review reported evidence on these entities and present our diagnostic experience based on the correlation with Gram stain. We recommend treatment with an antibiotic that has a very low minimum inhibitory concentration against lactobacilli and is effective against enterobacteria and Gram-positive cocci, which are responsible for these entities (aerobic vaginitis and desquamative inflammatory vaginitis)

Se estima que entre el 15 y el 50% de las mujeres que tienen trastornos del flujo vaginal, éstos no pueden atribuirse a una etiología infecciosa clara. Algunas de ellas desarrollarán problemas vulvovaginales crónicos difíciles de diagnosticar y tratar, incluso por especialistas. Son trastornos que plantean desafíos reales en el diagnóstico clínico y en su tratamiento como la vaginitis aeróbica, la vaginitis inflamatoria descamativa, la vaginitis atrófica y la vaginitis citolítica. Para diagnosticarlos, algunos investigadores han establecido una puntuación basada en la observación microscópica mediante contraste de fases. En este artículo, se revisa la evidencia publicada sobre estas entidades y presentamos nuestra experiencia en la correlación diagnóstica con la tinción de Gram. Se recomienda el tratamiento con un antibiótico con una concentración mínima inhibitoria muy baja contra los lactobacilos y eficaz contra las enterobacterias y los cocos grampositivos, responsables de estas entidades (vaginitis aeróbica y vaginitis inflamatoria descamativa)

Aetiology & risk factors of recurrent vaginitis & its association with various contraceptive methods.

BACKGROUND & OBJECTIVES: Women who do not seek treatment for recurrent vaginitis have risk to acquire other sexually transmitted infections. Besides proper antibiotic treatment, male condom acts as a barrier to various infections. Present study was done to assess type of vaginitis, its association with various contraceptive methods and need of male condom in prevention of recurrent vaginitis. METHODS: Prospective hospital based cohort study with a total of 400 women with recurrent vaginitis was done. Wet mount and Gram's staining examination were done to diagnose type of vaginitis. After treatment, proper counselling about good hygiene and use of male condom for 4 months in addition to their contraceptive method was advised. Patients were called after four months or when they developed symptoms of vaginitis. RESULTS: Tubal ligation (38.8%) and non contraceptives (34.0%) were the most common methods used by recurrent vaginitis patients. Bacterial vaginosis (BV, 53.8%) and mixed infection (36.8%) were commonly seen infections. BV was not observed in OC pill users. Overall post-treatment cure was 89.1 per cent. INTERPRETATION CONCLUSIONS: Our findings showed that male condom use provided protection against recurrent vaginitis and its use should be promoted with other contraceptive methods in high risk cases. Female condom may be another option.

Expansion of altered vaginal flora states in vaginitis to include a spectrum of microflora.

OBJECTIVE: To define the existence of 2 patterns of altered vaginal flora in symptomatic women identified on wet preparations that are not in the current vaginitis classification system. STUDY DESIGN: Testing of vaginal secretions from gynecologic patients at Mayo Clinic, Scottsdale, Arizona, who presented with vulvo-vaginal symptoms by vaginal pH, whiff testing, and saline and potassium hydroxide wet preparations. Over 14 years, approximately 5,000 samples were analyzed. Wet preparations were analyzed under low- (x 100) and high-power (x 400) phase-contrast microscopy. RESULTS: The first pattern has mixed bacteria with few or no lactobacilli, increased leukocytes and elevated pH. This pattern has a spectrum of severity, with the severe form meeting the diagnostic definition of desquamative inflammatory vaginitis. The mild-to-moderate form, termed inflammatory vaginitis, falls outside established diagnostic categories. The second pattern also has a spectrum of severity. The mild-to-moderate form, termed noninflammatory vaginosis, has mixed bacteria speckling squamous cells (but not obscuring edges), few or no lactobacilli, no leukocyte response and mildly elevated pH. This form differs from the severe form, which meets Amsel's criteria for bacterial vaginosis. CONCLUSION: The current classification system requires revision because it oversimplifies and ignores the full spectrum of altered vaginal microflora.

Vulvitis and vaginitis.

Although the vulva and vagina are embryologically and histologically different, proximity results in inflammatory conditions which commonly affect both regions. Patients often confuse 'vulvitis' and 'vaginitis' in characterizing symptoms. It is the job of the clinician to recognize inflammatory conditions specific to vulva and vagina, as well as to understand that inflammatory conditions can often involve both areas. This review of recent literature does not pretend to be comprehensive. Rather, it highlights specific conditions and research questions of recent interest.

Problem-orientated categorisation of "other conditions" seen in a genitourinary medicine clinic.

The case sheets of patients coded as D2 (other conditions requiring treatment) and D3 (other conditions not requiring treatment) in 1981 were reclassified on a problem-orientated basis. Ten discreet categories were delineated with ease. Women with non-specific vaginitis and men with Gardnerella vaginalis urogenital infection, usually coded D2 or C4, should be reclassified under the C group of conditions as, for example, "Gardnerella or other bacterial genital infections." It is suggested that codes D2 and D3 be replaced by the following nine categories: genital skin lesions or rashes; genitourinary symptoms; enteric conditions; other sexually transmitted infections; normal genital architecture, congenital conditions, or unconfirmed genital discharges; asymptomatic patients attending for routine examination; uninfected contacts of patients with sexually transmitted diseases; psychosexual problems; and others.

"Non-specific" vaginitis: a non-entity.

The author alleges that any knowledgeable physician owning a vaginal speculum and a microscope should rarely find the need for using the diagnosis, "non-specific" vaginitis, and that its too frequent use might well imply carelessness, indifference or a failure to employ available diagnostic methods. The suggestion is made that if the term "non-specific" vaginitis is to be retained in gynecologic nomenclature it should be assigned its rightful position and should include only those conditions without assignable etiology. The evidence shows that Gardnerella vaginalis (Haemophilus vaginalis, Corynebacterium vaginale) vaginitis is a precisely defined, specific vaginal infection, that the disease is sexually transmitted and that it accounts for most vaginitides previously classified as "nonspecific".