Women with vaginal discharge should undergo clinical examination of the lower genital tract and laboratory tests, such as vaginal pH and microscopy of vaginal discharge. Results of this evaluation help to determine the etiology of the vaginitis. The clinical features associated with noninfectious causes of vaginitis are generally indistinguishable from infection related syndromes.
is usually due to estrogen induced changes in cervicovaginal secretions. Vaginal and cervical examination, vaginal pH, and findings on microscopy are all normal. Treatment is unnecessary.
Vaginal discharge and symptoms of vulvovaginal discomfort can be caused by irritants (eg, scented panty liners, pads, spermicides, povidone-iodine, soaps and perfumes, and some topical drugs) and allergens (eg, latex condoms, topical antifungal
agents, seminal fluid, chemical preservatives) that produce immunologic acute and chronic hypersensitivity reactions, including contact dermatitis
. Identifying and eliminating the offending agent is generally adequate treatment.
Desquamative inflammatory vaginitis
is a rare cause of chronic vaginal discharge. It is characterized by purulent vaginal discharge, vulvovaginal burning or irritation, dyspareunia, and vulvar and vaginal erythema. The diagnosis is based on the presence of purulent vaginal discharge, leukocyte to epithelial cell ratio greater than 1:1, and vaginal pH greater than 4.5, after excluding bacterial vaginosis
, N. gonorrhoeae, C. trachomatis, and T. vaginalis infection. We suggest 2% clindamycin or 10% hydrocortisone cream
intravaginally at bedtime for four weeks
Cervicitis can present with vaginal discharge that may be confused with vaginitis. Neisseria gonorrhoeae
and Chlamydia trachomatis are the two most common causes, followed by herpes simplex virus.