Vaginitis and Vulvar Conditions

Women with vaginitis often present to primary care settings. The most common types of vaginitis are bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. Less commonly, vaginitis results from a noninfectious etiology. In addition to vaginitis, a woman presenting with vaginal discharge may have physiologic discharge, cervicitis, or pelvic inflammatory disease; it is critical to exclude an upper genital tract infection in women presenting with vaginal discharge. Clinical assessment includes a combination of history, exam, assessment of vaginal pH, the whiff test, microscopy, and/or point-of-care testing for the three common infectious causes. Yeast vaginitis and bacterial vaginosis often recur, necessitating review of contributing factors and consideration of long-term management. Although vulvar symptoms more commonly result from discharge originating from the vagina or cervix, primary vulvar processes also occur and can present with pruritus, burning pain, dyspareunia, dysuria, or rarely with bleeding or a palpable mass. Primary vulvar conditions include contact and allergic dermatitis, chronic vulvar dermatoses, vulvar malignancies, and vulvodynia.