Vaginitis is inflammation of the vagina that causes abnormal discharge, odor, itching or irritation. The three main causes are bacterial vaginosis, vulvovaginal candidiasis (yeast) and trichomoniasis, and each needs its own treatment.
Key symptoms
- Change in discharge: thin gray, thick white or frothy yellow-green
- Fishy odor, often stronger after sex (bacterial vaginosis)
- Vulvar itching, burning and redness (yeast)
- Pain during sex or burning when urine touches irritated skin
What you find on exam
- Vulvar redness, swelling or small cracks
- Speculum exam: amount, color and texture of the discharge
- Small red spots on the cervix (strawberry cervix) in trichomoniasis
- Check for cervical motion tenderness to rule out pelvic inflammatory disease
Tests
- Vaginal pH: above 4.5 in bacterial vaginosis and trichomoniasis, normal in yeast
- Wet mount for clue cells and moving trichomonads; KOH prep for yeast buds and hyphae and a whiff test
- Nucleic acid amplification tests (NAAT) for trichomonas, gonorrhea and chlamydia
- Pregnancy test when relevant; yeast culture if infections keep coming back
Treatment basics
- Bacterial vaginosis: metronidazole by mouth or vaginal gel, or clindamycin vaginal cream
- Yeast: a single dose of fluconazole or a vaginal azole cream
- Trichomoniasis: metronidazole 500 mg twice daily for 7 days and treat sex partners
- Avoid douching and scented products; come back if symptoms persist
Red flags
- Fever, pelvic pain or cervical motion tenderness (possible pelvic inflammatory disease)
- Bacterial vaginosis or trichomoniasis in pregnancy, linked to preterm birth
- Yeast infections that keep coming back, which may point to diabetes or a weak immune system
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.