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Last reviewed: 21 Apr 2025
Last updated: 21 Mar 2025

Summary

Your Organizational Guidance

ebpracticenet urges you to prioritize the following organizational guidance:

Vulvovaginitis en vaginosePublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2017Vulvovaginite et vaginosePublished by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2017

Definition

History and exam

Key diagnostic factors

  • vaginal discharge
  • dysuria
  • discharge adherent to vaginal mucosa

Other diagnostic factors

  • prior episodes
  • pruritus
  • vulvodynia
  • vaginal dryness
  • dyspareunia
  • erythema
  • pale epithelium
  • shiny epithelium
  • decreased elasticity
  • friable epithelium
  • fever
  • vaginal bleeding
  • abdominal pain
  • strawberry cervix

Risk factors

  • douching
  • poor or excessive hygiene
  • antibiotic use
  • change in feminine hygiene products and/or soap
  • HIV infection
  • diabetes
  • black women
  • intrauterine device
  • oral contraceptive pill use
  • latex condom/diaphragm
  • reproductive age
  • menopause
  • multiple or new sex partners
  • tobacco
  • increased frequency of intercourse
  • pregnancy

Diagnostic tests

1st tests to order

  • vaginal pH
  • amine "whiff" test of vaginal secretions
  • wet mount microscopy of vaginal secretions
  • Gram stain of vaginal secretions
  • HIV test
  • nucleic acid amplification test (NAAT)
  • venereal disease research laboratory (VDRL) test
  • serum rapid plasma reagin (RPR) test

Tests to consider

  • culture of vaginal secretions
  • polymerase chain reaction (PCR) for trichomoniasis on vaginal secretions
  • rapid enzyme tests of vaginal secretions

Treatment algorithm

Contributors

Authors

Diego Illanes, MD, FACOG, FACS
Diego Illanes

Medical Director

Urogynecology

Milford Regional

Milford

MA

Disclosures

DSI is an advisor for Coloplast, Medtronic and Vicarious.

Peer reviewers

David Chelmow, MD

Chair

Department of Obstetrics and Gynecology

Virginia Commonwealth University

Richmond

VA

Disclosures

DC declares that he has no competing interests.

Jonathon Solnik, MD

Director

Minimally Invasive Gynecologic Surgery

Cedars-Sinai Medical Center

Los Angeles

CA

Disclosures

JS declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.Full text  Abstract

American College of Obstetricians and Gynecologists. Vaginitis in nonpregnant patients: ACOG practice bulletin, number 215. Obstet Gynecol. 2020 Jan;135(1):e1-e17. Abstract

Reference articles

A full list of sources referenced in this topic is available here.

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