Vaginitis: Differential Diagnosis and Management - BPA Pathology

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BACTERIAL VAGINOSIS 2518. Altrichter T, Heizmann WR. Gardnerella vaginalis: transport,microscopy, testing resistance. Geburtshilfe Frauenheilkunde 1994; 54:606–1119. Hill GB. The microbiology of bacterial vaginosis. Am J Obstet Gynecol1993; 169:450–420. Peipert JF, Ness RB, Soper D, Bass D. Association of lower genitaltract inflammation with objective evidence of endometritis. Infect DisObstet Gynecol 2000; 8:83–721. Steinhandler L, Peipert JF, Heber W, Montagno A, Cruickshank C.Combination of bacterial vaginosis and leukorrhea as a predictor ofcervical chlamydial or gonococcal infection. Obstet Gynecol 2002; 99:603–722. Schmitt C, Sobel JD, Meriwether C. Bacterial vaginosis: treatmentwith clindamycin cream versus oral metronidazole. Obstet Gynecol1992; 79:1020–323. Nilsson U, Hellberg D, Shoubnikova M, Nilsson S, Mardh PA.Sexualbehavior risk factors associated with bacterial vaginosis and Chlamydiatrachomatis infection. Sex Transm Dis 1997; 24:241–6
4.BACTERIAL VAGINITISINTRODUCTIONBacterial vaginitis can be considered a pathologic entity separate frombacterial vaginosis, candidiasis, and trichomoniasis. It can originatefrom the introduction of a bacterium that overgrows the dominantbacterium of the vaginal ecosystem, or an alteration within theecosystem that causes Lactobacillus to lose dominance. In addition, oneor more of the endogenous pathogenic bacteria can gain dominance. Itis possible that when a significant alteration in the vaginal ecosystemoccurs, one or more of the endogenous bacteria can becomedominant and produce symptoms that are recognized as vaginitis.CLINICAL PRESENTATIONThe patient with bacterial vaginitis, regardless of the offendingbacterium, typically presents with a copious purulent vaginaldischarge. There can also be an associated discomfort that isfrequently described as ‘soreness’. The vaginal discharge has a pH of 5or higher, and this is consistent with a decrease in Lactobacillus growthand favorable to the growth of pathogenic bacteria. The vaginalepithelium is erythematous and at times beefy red.It is imperative that the physician rule out other causes of a purulentvaginal discharge, such as trichomoniasis and cervicitis, especiallycervicitis caused by Chlamydia trachomatis and Neisseria gonorrhoeae.Leukorrhea commonly occurs in patients with acute salpingitis;therefore, a work-up for the presence of sexually transmitted agents is
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