Clinical meaning
Vaginitis is inflammation of the vagina caused by infection, hormonal changes, or irritants. The three most common infectious types are bacterial vaginosis (BV), vulvovaginal candidiasis (yeast infection), and trichomoniasis. In a healthy vagina, Lactobacillus bacteria maintain an acidic pH (3.8-4.5) that prevents overgrowth of harmful organisms. When this balance is disrupted, pathogenic organisms overgrow. BV results from a shift in vaginal flora with overgrowth of anaerobic bacteria (primarily Gardnerella vaginalis). Candidal vaginitis results from overgrowth of Candida yeast, commonly after antibiotic use. Trichomoniasis is caused by the protozoan Trichomonas vaginalis and is sexually transmitted.
Exam relevance
Risk factors: - Antibiotic use (disrupts normal vaginal flora) - Douching - Multiple sexual partners - Unprotected sexual intercourse - Diabetes mellitus (elevated glucose promotes Candida growth) - Immunosuppression - Pregnancy (altered vaginal pH) - Tight-fitting or non-breathable clothing
Diagnostics: - Expect vaginal swab for wet mount microscopy - Monitor vaginal pH (BV and trichomoniasis have elevated pH above 4.5) - Expect whiff test (fishy odor with KOH indicates BV) - Expect STI screening if trichomoniasis confirmed - Monitor for cervical inflammation on examination