Vaginitis: case reports and brief review

Vaginitis is the most frequently gynecologic diagnosis encountered by physicians who provide primary care to women. Accurate diagnosis can be elusive, complicating treatment. Most experts believe that up to 90% of vaginitis cases are secondary to bacterial vaginosis, vulvo-vaginal candidiasis, and trichomoniasis. The diagnosis of vaginitis is based on the patient's symptoms, the physical examination, the findings of microscopic examination of the wetmount and potassium hydroxide (KOH) preparations, and the results of the pH litmus test. Additional cultures and testing may be needed for difficult-to-diagnose cases.

Isolation of Mobiluncus species from the human vagina

We report the results of a study concerning the characteristics of 52 strains of Mobiluncus spp. isolated from 982 vaginal secretions from patients with suspected bacterial vaginosis. 158 of these women presented the features of this bacterial infection. Of the strains isolated, 39 belonged to the species Mobiluncus curtisii, (25 of these which to M. curtisii subsp. curtisii and 14, to M. curtisii subsp. holmesii), and 13, to Mobiluncus mulieris. The vaginal isolates of Mobiluncus spp. were identified by comparing their biochemical profiles with those of the type strains M. curtisii subsp. holmesii (ATCC 35,242), M. curtisii subsp. curtisii (ATCC 35,241) and M. mulieris (ATCC 35,243). All strains of M. mulieris proved to be sensitive to the antimicrobial agents assayed, while strains of M. curtisii were seen to be resistant only to metronidazole.

Bacterial vaginosis: association with adverse pregnancy outcome

Bacterial vaginosis is the most common lower genital tract infection encountered among women of reproductive age. This condition can best be considered as a vaginal syndrome associated with an alteration of the normal vaginal flora rather than an infection specific to any one microorganism. Bacterial vaginosis is a clinical condition with a complex microbiology that is characterized by a reduced concentration of a normally abundant Lactobacillus species along with high concentrations of gram-negative and anaerobic bacteria, particularly, Gardnerella vaginalis and Mobiluncus, Bacteroides, Prevotella, and Mycoplasma species. The exact make up of the microorganisms and their relative concentration vary among women who have this condition. Although it was previously regarded as a harmless condition, recent work has linked bacterial vaginosis to numerous upper genital tract complications such as preterm labor and preterm delivery, preterm premature rupture of the membranes, chorioamnionitis, and postpartum endometritis. The findings from recent prospective randomized trials suggest that treatment of bacterial vaginosis in certain women who are at high risk for preterm delivery decreases the rate of preterm birth.

Clinical and microscopic diagnosis of vaginal yeast infection: a prospective analysis

STUDY OBJECTIVES

To evaluate the accuracy of clinical findings and direct microscopy in the diagnosis of yeast vaginitis.

DESIGN

Prospective.

SETTING

Urban teaching hospital emergency department and walk-in clinic.

PARTICIPANTS

Seventy-one consecutive nonmenstruating women with a presenting complaint of vaginal discharge, itching, or pain.

INTERVENTIONS

Trained emergency physicians and nurse practitioners, blinded to culture results, collected clinical information, examined vaginal secretions, and obtained yeast cultures. Treatment was based on clinical impression and not altered by the study. Associations between clinical and laboratory parameters and yeast culture results were evaluated.

RESULTS

Twenty-three patients (32.4%) had positive yeast cultures. Accepted risk factors were seen in patients with and without culture-positive yeast vaginitis. Clinical criteria for yeast vaginitis--including pruritus, caseous discharge, perineal edema or erythema, and patient self-diagnosis--were more common in women with yeast vaginitis but were seen with other causes of vaginitis. Watery discharge and amine odor (negative "whiff" test) were good predictors of an alternative diagnosis, but, again, accuracy was poor. Gram stain showing yeast was the most accurate laboratory method of diagnosis. Saline microscopy, potassium hydroxide, and methylene blue were all equal and only moderately accurate, with a significant proportion of false-negative and false-positive results.

CONCLUSION

Standard criteria for diagnosis of monilial vaginitis are relatively unreliable. Gram stain, absence of watery discharge, and patient self-diagnosis of "another yeast infection" are the best independent predictors of a positive culture.