Vaginitis vulvovaginitis
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Understanding Vaginitis and Vulvovaginitis: Causes, Diagnosis, and Treatment
Overview of Vaginitis and Vulvovaginitis
Vaginitis and vulvovaginitis are common conditions characterized by inflammation of the vagina and vulva, respectively. These conditions can cause symptoms such as abnormal vaginal discharge, odor, irritation, itching, and burning 7. The primary causes include bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis, with bacterial vaginosis being the most prevalent 7.
Vulvovaginal Candidiasis: Prevalence and Treatment
Prevalence
Vulvovaginal candidiasis (VVC) is the second most common cause of vaginitis globally, affecting up to 75% of women at least once in their lifetime 19. In Brazil, the estimated prevalence of VVC is around 18%, although this number may be higher due to underreporting and asymptomatic cases 2.
Diagnosis and Treatment
Diagnosis of VVC involves clinical signs and symptoms combined with potassium hydroxide microscopy or fungal culture to identify the specific Candida species 9. Treatment typically includes topical or oral antifungal medications, with azole antifungals being equally effective 1. For recurrent VVC, maintenance therapy with weekly oral fluconazole for up to six months is recommended 1.
Trichomoniasis: Detection and Management
Trichomoniasis, caused by the protozoan Trichomonas vaginalis, is a common non-viral sexually transmitted infection. It is best detected using antigen testing via vaginal swabs evaluated by immunoassay or nucleic acid amplification tests 1. Treatment involves oral metronidazole, with partner treatment enhancing cure rates 1. In pregnancy, treating symptomatic trichomoniasis with oral metronidazole is crucial to prevent preterm birth 1.
Bacterial Vaginosis: Diagnosis and Treatment
Bacterial vaginosis (BV) is diagnosed using clinical criteria (Amsel's criteria) or laboratory methods such as Gram stain 17. Treatment options include oral metronidazole, vaginal metronidazole gel, or clindamycin cream 17. For women with recurrent BV, longer courses of therapy are recommended 1.
Vulvovaginitis in Children
Vulvovaginitis is the most common gynecological complaint in children and young girls, often caused by non-specific factors such as poor hygiene and chemical irritants 35. Management includes hygiene measures, probiotics, and avoiding irritants. Specific treatment is necessary if a pathogen is identified 35.
Allergic Vulvovaginitis
Allergic vulvovaginitis is an under-recognized condition where the vaginal mucosa exhibits an allergic response similar to other mucosal surfaces like the nose and eyes 4. A variety of allergens can provoke these reactions, and proper diagnosis and management can significantly relieve symptoms 4.
Improving Diagnosis and Management
Accurate diagnosis of vulvovaginitis is crucial for effective treatment. Misdiagnosis rates are high, approaching 50%, which increases the risk of recurrence 6. Advances in molecular testing offer more sensitive and specific diagnostic options, which can improve patient outcomes and reduce healthcare costs 6.
Conclusion
Vaginitis and vulvovaginitis are prevalent conditions with significant impacts on women's health. Understanding the causes, accurate diagnosis, and effective treatment options are essential for managing these conditions. Advances in diagnostic methods and tailored treatment strategies can enhance patient care and reduce recurrence rates.
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Most relevant research papers on this topic
Vulvovaginitis: screening for and management of trichomoniasis, vulvovaginal candidiasis, and bacterial vaginosis.
Vulvovaginal candidiasis can be effectively managed with topical and oral antifungal azole medications, with partner treatment enhancing cure rates for trichomoniasis.
Systematic Review
Highly CitedPrevalence of vulvovaginal candidiasis in Brazil: a systematic review.
Vulvovaginal candidiasis prevalence in Brazil is 18%, but this number may be higher due to underreporting and asymptomatic cases.
Systematic ReviewClinical presentation, diagnosis and treatment of vulvovaginitis in girls: a current approach and review of the literature
Vulvovaginitis in girls is often caused by non-specific factors, and a comprehensive evaluation is necessary for diagnosis, differential diagnosis, and treatment.
Systematic ReviewAllergic vulvovaginitis.
Allergic vulvovaginitis can be caused by various allergens, hormones, menstrual cycle, and psychologic factors, with adequate management providing relief in most cases.
Systematic ReviewRecommendation : Vulvovaginitis
Vulvovaginitis in prepubertal and adolescent females should be diagnosed and treated based on age, history, and associated complaints, with counseling on hygiene and voiding techniques.
Systematic ReviewImproving the Diagnosis of Vulvovaginitis: Perspectives to Align Practice, Guidelines, and Awareness
Newer molecular tests can revolutionize the diagnosis of vulvovaginitis, reducing misdiagnosis and improving treatment outcomes.
Very Rigorous JournalVaginitis: Diagnosis and Treatment.
Bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis are the most common causes of vaginitis, and diagnosis and treatment rely on symptoms, physical examination, and laboratory testing.
Highly CitedDo we need to treat vulvovaginitis in prepubertal girls?
Prepubertal girls with vulvovaginitis should be treated based on clinical picture and microbiology, rather than just treating the presence of an organism.
Systematic Review
Rigorous JournalHighly CitedThe epidemiology, pathogenesis, and diagnosis of vulvovaginal candidosis: A mycological perspective
Fungal culture is crucial for accurately diagnosing vulvovaginal candidosis, as it reveals the species responsible for the infection and provides epidemiological data.
Highly CitedGuideline: Vulvovaginal candidosis (AWMF 015/072, level S2k)
Vulvovaginal candidosis (VVC) is a common and treatable condition in women, with local and oral antifungal treatments showing good results.
Highly Cited