Warning:

This document is being maintained for historical purposes, but is now out of date. To view current guidelines please visit:

• STD Treatment Guidelines   at http://www.cdc.gov/STD/treatment

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1993 Sexually Transmitted Diseases Treatment Guidelines

09/24/1993

SUGGESTED CITATION
Centers for Disease Control and Prevention. 1993 Sexually
transmitted diseases treatment guidelines. MMWR 1993;42(No. RR-14):
{inclusive page numbers}.

CIO Responsible for this publication:
National Center for Prevention Services,
Division of Sexually Transmitted Diseases and HIV Prevention

Management of the Patient with Vaginitis
     
     Vaginitis is characterized by a vaginal discharge (usually) or
vulvar itching and irritation; a vaginal odor may be present. The
three common diseases characterized by vaginitis include
trichomoniasis (caused by T. vaginalis), BV (caused by a
replacement of the normal vaginal flora by an overgrowth of
anaerobic microorganisms and Gardnerella vaginalis), and
candidiasis (usually caused by Candida albicans). MPC caused by C.
trachomatis or N. gonorrhoeae may uncommonly cause a vaginal
discharge. Although vulvovaginal candidiasis is not usually
transmitted sexually, it is included here because it is a common
infection among women being evaluated for STDs.

     The diagnosis of vaginitis is made by pH and microscopic
examination of fresh samples of the discharge. The pH of the
vaginal secretions can be determined by narrow-range pH paper for
the elevated pH (greater than 4.5) typical of BV or trichomoniasis.
One way to examine the discharge is to dilute a sample in 1-2 drops
of 0.9% normal saline solution on one slide and 10% potassium
hydroxide (KOH) solution on a second slide. An amine odor detected
immediately after applying KOH suggests either BV or
trichomoniasis. A cover slip is placed on each slide and they are
examined under a microscope at low- and high-dry power. The motile
T. vaginalis or the clue cells of BV are usually easily identified
in the saline specimen. The yeast or pseudohyphae of Candida
species are more easily identified in the KOH specimen. The
presence of objective signs of vulvar inflammation in the absence
of vaginal pathogens, along with a minimal amount of discharge,
suggests the possibility of mechanical or chemical irritation of
the vulva. Culture for T. vaginalis or Candida species is more
sensitive than microscopic examination, but the specificity of
culture for Candida species to diagnose vaginitis is less clear.
Laboratory testing fails to identify a cause among a substantial
minority of women.

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