Vaginitis is an extremely common infection. With many over-the-counter medications for vaginitis and the reports of efficient probiotic and alternative treatments, proper evaluation and treatment of women who present with vaginal complaints is very important. Symptoms: Inflammation of the vagina is the most common gynecological problem encountered by primary care physicians. Approximately 5 million women yearly visit a medical office for vaginitis. The symptoms of vaginitis may include itching, irritation, purulent or other discharge, and a foul odor. Many women, however, are asymptomatic. Symptoms of vaginitis may result from fungal, bacterial, or protozoan infections, atrophy, cervicitis, genital ulcers, dermatological diseases (such as lichen planus or psoriasis), vulvar intraepithelial neoplasia, mechanical trauma or irritation, and allergic reactions. Candidal infections, bacterial vaginitis, and trichimonas are the three most common causes of vaginitis (Table 13.1). Etiology, symptoms, and diagnosis. Bacterial causes: Bacterial vaginosis (BV) is the most common cause of vaginitis in the USA, accounting for 40 to 50% of cases of vaginitis in women of childbearing age, and the second most common cause of vaginitis in Europe with a prevalence of 30%. BV is caused by an overgrowth of Guardnerella vaginalis and other gram-negative rods. What causes the overgrowth is not completely understood. Recurrent episodes of BV are associated with a regular sex partner, a female sex partner, and a past history of BV. BV is not associated with use of oral contraceptives. BV may be transmitted sexually, but primarily is caused by changes in the vagina. BV has been linked to complications in pregnancy (Table 13.2).
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