Vaginal Discharge/Vaginitis

Basics

Description

  • Secretions from cervix and vagina, varying in color, consistency, and odor, influenced by hormonal and pathologic factors
  • Vaginitis: An inflammation of the vagina characterized by symptoms such as abnormal discharge, itching, burning, irritation, and pain, often caused by infections, hormonal changes, or irritants
  • Vaginosis: A condition involving a disruption of the normal vaginal microbiota without significant inflammation, commonly seen in bacterial vaginosis, which presents with abnormal discharge and odor but minimal irritation
  • Changes in discharge may include quantity, odor, quality, or color
  • Physiologic discharge:
    • Changes to vaginal discharge occur naturally throughout the menstrual cycle from estrogen-driven secretions
    • Glands in the cervix produce clear mucus that may turn white or yellow when exposed to air
  • Infectious discharge occurs due to bacterial, fungal, protozoal, or viral infections
  • Inflammatory discharge caused by noninfectious causes of vaginal irritation
  • Atrophic discharge occurs due to low estrogen, common postmenopause
  • Malignant discharge occurs from gynecologic cancers
  • Up to 30% of ED cases of vaginal discharge involve infection
  • Bacterial vaginosis is the most common cause (40–50% cases)
  • Vulvovaginal candidiasis accounts for 20–25% of cases
  • Trichomoniasis diagnosed in 10–20% of symptomatic patients
  • Empiric treatment in ED leads to misdiagnosis in 42% of cases

Etiology

  • Bacterial vaginosis (BV):
    • Most common cause
    • Decrease in normal Lactobacillus sp flora (eg, antibiotics)
    • Disruptions in normal vaginal pH
    • Overgrowth of normally present bacteria such as Gardnerella vaginalis, Mycoplasma hominis, Mobiluncus sp, Prevotella sp, and Peptostreptococcus sp
  • Bacterial infections:
    • Trichomonas vaginalis (trichomoniasis)
    • Group A strep
    • Staphylococcus aureus
  • Fungal infections:
    • Candida sp most common
    • Often underlying immune dysfunction:
      • Diabetes
      • HIV
  • Sexually transmitted disease:
    • Chlamydia cervicitis
    • Gonococcal cervicitis
    • Mycoplasma genitalium cervicitis and vaginitis
  • Chemical irritants
  • Foreign body
  • Atrophic vaginitis:
    • Genitourinary syndrome of menopause
    • Condition characterized by thinning, drying, and inflammation of the vaginal epithelium due to estrogen deficiency
  • Lichen sclerosis:
    • Autoimmune-mediated, chronic inflammatory skin disorder
  • Desquamative inflammatory vaginitis:
    • Rare, chronic, noninfectious vaginal inflammation with purulent discharge
    • Often linked to immune dysfunction and lactobacilli deficiency
  • Hypersensitivity
  • Collagen vascular disease
  • Herpes simplex virus (HSV):
    • Vulvovaginitis
    • Cervicitis
  • Fistula (eg, colovaginal)

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