Differential diagnosis of vaginal infectious conditions. Literature review

Eglė Jankuvienė1, Greta Jankutė1, Deimantė Sadauskaitė1 

1Lithuanian University of Health Sciences, Faculty of Medicine


Vaginitis is an inflammation of the vagina that can cause non-specific vulvovaginal symptoms, such as: vaginal discharge, itching of the vulva, burning sensation in the vagina, painful sex or bleeding afterwards, and others. The cause is usually a change in the balance of bacteria in the normal vagina or an infection. Decreased estrogen levels after menopause and some skin disorders can also cause vaginitis. Risk factors for vaginitis include a foreign body in the vagina, poor hygiene, atrophic changes in postmenopausal women, chemical irritation caused by urine, feces, or cosmetics. The most common causes of vaginitis are bacterial vaginosis, Candida– induced vulvovaginitis, and trichomoniasis. Sexual activity is a risk factor for bacterial vaginosis. Trichomoniasis, is one of the most common non-viral sexually transmitted diseases (STDs) worldwide. When diagnosing vaginitis, the initial assessment usually includes the evaluation of complaints and secretions, smear or culture results, and other tests (nucleic acid amplification test is the gold diagnostic standard for trichomoniasis – PCR test from clinical material). Bacterial vaginosis is characterized by abundant, homogeneous, fishy odor vaginal discharge. However, even half of the patients do not feel ony of the symptoms. Vaginal candidiasis is characterized by odorless vaginal discharge of curd consistency, accompanied by itching of the vulva, pain, dyspareunia, redness of the vaginal walls, edema, cracks in the skin. Sometimes vaginal candidiasis is asymptomatic. Foamy yellowish-green vaginal discharge, accompanied by vulvar itching, irritation, dysuria, and sometimes lower abdominal discomfort, characterise of Trichomonas vaginalis-induced vaginal inflammation. Erythema of the vulva and “strawberry cervix” are also seen in trichomoniasis. However, as many as half of those with symptoms may not feel it. It is important to distinguish vaginitis from the cervicitis caused by gonorrhea or chlamydia. This always requires laboratory evaluation. Differential diagnosis of vaginal inflammation is important because treatment tactics depend on it.

Keywords: vaginitis, bacterial vaginosis, Candida, trichimoniasis, aerobic vaginitis.