Vaginitis: Differential Diagnosis and Management - BPA Pathology

98 VAGINITIS: DIFFERENTIAL DIAGNOSIS AND MANAGEMENTsolution entering the upper genital tract. Some investigators believethat there is an association between douching and the development ofpelvic infection.The goal of treatment is not to significantly increase the pH sincethis can result in a decrease in Lactobacillus growth and an increase inthe growth of other bacteria. Therefore, it would be detrimental tomaintaining a balanced vaginal ecosystem to raise the pH above 4.5.Perhaps the administration of intravaginal clindamycin cream (2%) ormetronidazole can effectively lower the concentration of Lactobacilluswhile suppressing the growth of obligate anaerobic bacteria.Clindamycin will also have an inhibitory effect on Gram-positivebacteria, except the enterococci. Additionally, clindamycin would nothave a suppressive effect on the Gram-negative facultative bacteria.Therefore, the administration of oral or intravaginal antibiotics shouldnot be for a prolonged period of time in order to avoid selection ofresistant bacteria, which could become the dominant bacteria of thevaginal ecosystem.REFERENCES1. Düderlein A. Die Scheidensekretunter Suchungen. Zentralbl Gynakol1982; 18:10–142. Cibley LJ, Cibley LJ. Cytolytic vaginosis: a common cause of vaginitis.In Horowitz BJ, Mardh PA, eds. Vaginitis and Vaginosis.New York:Wiley-Liss, 1991; 181–73. Aroutcheva A, Gariti D, Simon M, et al.Defense factors of vaginallactobacilli. Am J Obstet Gynecol 2001; 185:375–94. Vasquez A, Jakobsson T, Ahrne S, Forsum U, Molin G. Vaginallactobacillus flora of healthy Swedish women. /Clin Microbiol 2002; 40:2746–9