Practice Practice Pointer

Persistent vaginitis

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d7314 (Published 29 November 2011) Cite this as: BMJ 2011;343:d7314
  1. Gayle Fischer, associate professor of dermatology 1,
  2. Jennifer Bradford, conjoint senior lecturer in gynaecology 2
  1. 1University of Sydney, Sydney Medical School, PO Box 4028, Royal North Shore Hospital, LPO, St Leonard’s, New South Wales, Australia
  2. 2University of Western Sydney, Campbelltown, Australia
  1. Correspondence to: G Fischer gayle.fischer{at}sydney.edu.au

Persistent vaginitis can be a challenging problem in general practice. We review the steps to accurate diagnosis and effective treatment.

A 36 year old woman visits her general practitioner complaining of a six month history of vaginal soreness, itch, discharge, dyspareunia, and painful postcoital vulval swelling. Her symptoms are worse premenstrually and improve during menstruation. She reports that she has had recurrent “thrush” since her mid-20s, precipitated by courses of antibiotics, and has successfully self medicated with intravaginal miconazole. These episodes have gradually become more frequent, and recently her symptoms failed to resolve with over the counter antifungals. Although she had been known to have positive swabs for Candida albicans in the past, recent swabs and vaginal microscopy had been persistently negative. She is healthy and does not have diabetes, and her only medication is the oral contraceptive pill with 30 µg oestrogen. A trial of pill cessation did not improve her problem. She is very embarrassed about this problem and, when asked, she volunteers that she is worried that she may have somehow contracted genital herpes or cancer. Examination shows a confluent, oedematous vulvovaginitis extending to the labia majora, with associated fissuring; erythema of the perineum; and erythema of the vagina.

In this article we explore the features of persistent vaginitis and suggest recommendations for managing the condition.

Methods

We assessed previous publications on persistent vaginitis, including several from our group. We conducted a literature search using Medline and PubMed databases up to August 2011. We found few systematic reviews and randomised controlled trials and cohort studies on persistent vaginitis; however, we also selected several well conducted and convincingly reported case series and narrative reviews by respected authors. Our suggestions in this article are based on these publications and on our own clinical experience in a large dermatogynaecology practice.

What is persistent vaginitis?

Vaginitis …

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