Vaginitis is the cause for more than 10 million office visits each year. The most common diagnoses are bacterial vaginosis (BV), yeast vaginitis (candidiasis), and trichomoniasis.
Bacterial vaginosis is the most common (up to 50%) of vaginal infections. BV can pose particular risks during pregnancy. Increased anaerobic bacteria, reduced levels of the normal Lactobacillus flora, and the presence of clue cells on microscopic examination can indicate BV. Culture and sensitivities identify bacterial overgrowth and indicate appropriate treatment.
Vaginal candidiasis is the second most common form of vaginal infection. Most adult women will experience at least one episode of vaginal candidiasis during their lifetime. For resistant yeast infections, sensitivities can be especially helpful by indicating the most appropriate treatment options.
Trichomoniasis, a non-reportable sexually transmitted disease, has been estimated to affect 3 million women annually in the United States. A wet saline mount in the office is the most sensitive manner to detect the motile trichomonads, but in symptomatic infections later analysis in the laboratory often identifies this protozoan.
The differential diagnosis of vaginal infections requires identification of the causative agent or agents, as simultaneous infection with more than one organism is common. Identification of these organisms includes microscopic examination, Gram stain, and culture. Sensitivities are run on cultured dysbiotic organisms to indicate appropriate treatments.