Nonspecific Vaginitis: Clinical Picture, Diagnosis, Treatment

Nonspecific vaginitis – inflammation of the vaginal mucosa, caused by opportunistic vaginal flora.

Among the etiologic causes of nonspecific vaginitis, Escherichia coli occupies a separate place, and poor or improper hygiene is an etiologic factor. Patients with hypoestrogenemia are often diagnosed with vaginitis associated with streptococcal infection.

Patient complaints and clinical manifestations of nonspecific vaginitis regardless of the etiologic factor will be similar.

Risk factors

Risk factors include menses, bathing (especially bubble bath), use of over-the-counter intravaginal hygiene products, multiple sexual partners, use of intrauterine devices, and presence of other sexually transmitted diseases. Increased prevalence was associated with cigarette smoking, obesity, loneliness, previous pregnancy, and history of induced abortion.

Clinical picture

Heavy vaginal discharge, gray or yellow, dyspareunia, dysuria. Vaginal itching and erythema may be present. Burning, pain or vaginal bleeding is rare. During gynecological examination in mirrors, hyperemic vaginal mucosa is visualized. The discharge is not accompanied by a specific odor.

Diagnosis

1. Microscopy of wet vaginal swabs

Microscopy of wet vaginal smears: microscope magnification (10X) is used to assess the types of epithelial cells present (mature, parabasal, basal or key cells) and to establish the presence of yeast or pseudohyphae. A lens (40X) is used to count organisms and cells in the field. In nonspecific vaginitis, Lactobacillus counts are decreased and cocci counts are increased. Lactobacillus species will appear as large rods. Trichomonas vaginalis is a flagellated protozoan, slightly larger in size than a white blood cell. Yeast cells are similar in size to red blood cells. The pseudohyphae represent several buds that form chains.

2. Treatment with 10% KOH (amine test)

A separate sample of vaginal secretions is used for treatment with 10% KOH. An increase in anaerobic bacteria(G. vaginalis, Mobiluncus, etc.) will result in the production of amines. Addition of KOH will result in amine evaporation and a “fishy” odor, indicating the presence of bacterial vaginosis.

3. DNA technologies (molecular diagnostic methods)

DNA technology is a highly sensitive diagnostic method. The method can be used to detect G. vaginalis, Candida, Trichomonas vaginalis, Schlamydia, Neisseria gonorrhoeae, as well as G . vaginalis , Prevotella species, Mobiluncus species , G. vaginalis, A. vaginae, E. coli., Streptococcus spp., Staphylococcus spp . and others. Different species of Lactobacillus(L. crispatus and L. jensenii, L. gasseri) can also be determined. In the nonspecific form of vaginitis, there are no specific pathogens.

4. pH testing

A pH test is performed with a test strip placed directly into the vagina along the side wall. This type of vaginitis is characterized by an elevated pH greater than 4.5. The presence of cervical discharge, semen, and blood can falsely inflate the pH.

5. Gram’s microscopy (Nugent)

Microscopic examination of the vaginal smear with Gram staining and Nugent’s scale evaluation.

Cell culture isolation has a limited role in the evaluation of vaginitis, but is necessary in forms of vaginitis resistant to standard treatment to determine antibiotic sensitivity.

Treatment of nonspecific vaginitis

Recommended for women with the presence of symptoms. Treatment regimens:

• Metronidazole 500 mg orally.
• Metronidazole gel 0.75% one applicator vaginally.
• Clindamycin cream 2% one applicator intravaginally.
• Clindamycin in suppositories 100 mg intravaginally.

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Treatment of pregnant women

Treatment is recommended for all symptomatic pregnant women. It is associated with adverse pregnancy outcomes including premature rupture of the fetal membranes, preterm labor, intra-amniotic infection, and postpartum endometritis. Oral metronidazole is effective during pregnancy. No significant difference in treatment efficacy has been established between the oral form of metronidazole and the vaginal form. Modern studies show high safety and efficacy of clindamycin in pregnant women.