Vaginitis: Differential Diagnosis and Management - BPA Pathology

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HEALTHY VAGINAL ECOSYSTEM 912. Wheater DM, Hirsch A, Mattick TR. Possible identity of‘lactobacillin’ with hydrogen peroxide produced by lactobacilli. Nature( London)1952; 170:623–413. Eschenbach DA, Davick PR, Holmes KK, et alPrevalence of hydrogenperoxide producing Lactobacillus species in normal women andwomen with bacterial vaginosis. /Clin Microbiol 1989; 27:251–614. Klebanoff SJ. lodination of bacteria: a bactericidal mechanism. J ExpMed 1967; 126:1063–7815. Klebanoff SJ. Myeloperoxidase-halide-hydrogen peroxide antibacterialsystem. /Bacteriol 1968; 95:2131–816. Klebanoff SJ. Myeloperoxidase-mediated antimicrobial systems andtheir role in leukocyte function. In Schultz J, ed. Biochemistry ofPhagocytic Process. Amsterdam: North-Holland Publishing Company,89–11017. Reite B, Oram JD. Bacterial inhibitors in milk and other biologicalfluids. Nature 1967; 216:328–3018. Aroutcheva AA, Simoes JA, Faro S. Antimicrobial protein producedby vaginal Lactobacillus acidophilus that inhibits Gardnerella vaginalis.Infect Dis Obstet Gynecol2001; 9:33–919. Simoes JA, Aroutcheva A, Heimler I, Shott S, Faro S. Bacteriocinsusceptibility of Gardnerella vaginalis and its relationship to biotype,genotype, and metronidazole susceptibility. Am J Obstet Gynecol 2001;185:1186–9020. Gardner HL, Dukes CD. Haemophilus vaginalis vaginitis. Am J ObstetGynecol 1955; 69:962–76
2.VULVITISOften, conditions that affect the vulva are mistaken for vaginitis,resulting in unnecessary treatments and expense. These treatmentsmay even cause alterations in the endogenous vaginal microflora thatresult in symptomatic vaginosis or vaginitis. Additionally, the variouscreams, ointments, suppositories, and emulsions may cause ahypersensitivity reaction in the tissues of the vulva.Therefore, it is extremely important that the physician establishesand locates the precise anatomical site where the patient’s symptomsare originating. This can easily be achieved by having the patientpoint, with her index finger, to the area that is bothersome. Thepatient with an inflammatory condition of the vulva (vulvitis), forexample vulvadynia, vestibulitis, vulva hyperplasia, or lichen sclerosus(Table 4), is often extremely uncomfortable, has difficulty sitting for aprolonged period, and cannot have sexual intercourse. Therefore shemay not be able function at full capacity. The physician should take adetailed history with regard to onset of first symptoms. This isimportant because when given an opportunity to consider hercondition, the patient often will relate that her symptoms began longbefore the vulvitis became chronic. It is important that the physicianallow the patient ample time to not only describe her condition, butalso explain the factors that impinge on her condition. The physicianmust establish that her symptoms are actually related to a clinicalcondition that can be detected on the vulva or the vagina, or both.The vulvar dystrophies are a group of conditions that are placedtogether based on gross and histopathologic characteristics. Thevulvar dystrophies, or nonneoplastic epithelial disorders, are divided
Page 3 and 4: VAGINITISDifferential Diagnosis and
Page 5 and 6: CONTENTSColor illustrations v1. Hea
Page 7 and 8: viFigure 4 Gram stain of vaginal fl
Page 9 and 10: viiiFigure 8 Cytolytic vaginosis. N
Page 11 and 12: xrelative absence of white blood ce
Page 13 and 14: xiiFigure 16 Cytolytic vaginosis. W
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