Vaginitis: Differential Diagnosis and Management - BPA Pathology

9.CYTOLYTIC VAGINOSISINTRODUCTIONCytolytic vaginosis, also referred to as Döderlein cytolysis, appears tobe a common alteration in the vaginal ecosystem 1 . Cytolytic vaginosisis similar in gross appearance to the discharge that is seen with vaginalcandidiasis. When examining a patient with cytolytic vaginosis,physicians often do not see yeast but still treat the patient with an antifungalagent, and the patient’s condition does not resolve.CLINICAL PRESENTATION AND DIAGNOSISThe external genitalia do not undergo any changes with cytolyticvaginosis, unlike with candidiasis. The patient with vaginal candidiasisoften has vulvar involvement, i.e. the labia and crural folds areerythematous, pruritic, and/or burn. However, the patient withcytolytic vaginosis can complain of vaginal pruritis and burning,dyspareunia, and vulvar burning when micturating (vulvar dysuria).The patient’s symptoms intensify during the luteal phase of themenstrual cycle 2 . The microflora of patients with cytolytic vaginosisdoes not shift to a flora dominated by facultative or obligate anaerobesbut is dominated by Lactobacillus. In fact, there appears to be anovergrowth of lactobacilli. The pH of the vagina and the vaginaldischarge remains between 3.5 and 4.5. The hydrogen ionconcentration is maintained by the growth of lactobacilli. Productionby lactobacilli of lactic acid and other organic acids maintains thishydrogen ion concentration and suppresses the growth of other