Vaginitis: 3 Infectious Causes
Gardnerella
Bacterial
Exam: Thin, off-white discharge, fishy odor, no inflammation
Lab: pH > 4.5, Clue cells, Positive Whiff test using KOH to react w amines
Treatment: Metronidazole: reduced metronidazole in anaerobic environments disrupts DNA synth by an incompletely understood mechanism. OR Clindamycin: Inhibits 50S rRNA.
Trichomonas
Protozoan
Exam: Thin, yellow/green, VERY malodorous, frothy discharge. Strawberry cervicitis, vaginal inflammation.
Lab: pH > 4.5, motal trichomonads via saline microscopy.
Treatment: treat the partner too! (yeah, grow that practice!) w Metronidazole
Candida vaginalis
Fungus
Exam: Thick, cottage-cheese discharge, Vaginal inflammation. (often Hx of antibiotic use, Gr+ Lactobacilli are protective)
Lab: Normal pH, pseudohyphae
Treatment: Fluconazole-inhibits fungal P450 enzyme, prevents ergosterol formation
Plus: does she wash her vagina? May simply be d/t harsh cleansing agents. Tx: Discontinue.
Note: N. gonnorrhoea is an enflamed cervix, not vagina, with vaginal discharge. Vaginal vesicles? HSV2 > HSV1. Tx: Acyclovir 5x daily (water sol.).
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