Symptoms alone not enough to diagnose vaginitis

Between 5 and 10 million women each year seek gynecologic advice regarding vulvovaginal disorders, or vaginitis.¹ Defined as inflammation or infection of the vagina, vaginitis presents a spectrum of symptoms, including itching, burning, irritation, dyspareunia, vaginal odor and abnormal vaginal discharge.² The most common causes are bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomoniasis (TV). Among patients with vaginal symptoms, BV is diagnosed in 22% to 50% of cases, VVC in 17% to 39% of cases, and TV in 4% to 35% of cases. Picture1-3

Because vaginitis is a global term for a nonspecific syndrome, and because the condition has three distinct etiologies (i.e., BV, VVC, TV) with three different groups of causative organisms, accurate differential diagnosis is essential for effective treatment.² Clinicians cannot rely on symptoms alone to identify its cause.

Bacterial Vaginosis

Bacterial vaginosis is the most common cause of vaginal symptoms among women.³ The prevalence in the United States is estimated to be 21.2 million (29.2%) among women ages 14–49. Most women found to have BV (84%) reported no symptoms.

It is a global concern as well.⁴ General population prevalence ranges from 23% to 29% across regions: Europe and Central Asia, 23%; East Asia and Pacific, 24%; Latin America and Caribbean, 24%; Middle East and North Africa, 25%; sub-Saharan Africa, 25%; North America, 27%; South Asia, 29%).

BV is a vaginal dysbiosis (i.e., an imbalance of “good” and “harmful” bacteria in the vagina)⁵ resulting from replacement of normal hydrogen peroxide and lactic-acid–producing Lactobacillus species in the vagina with high concentrations of anaerobic bacteria, including G. vaginalis, Prevotellaspecies, Mobiluncus species, A. vaginae, and other BV-associated bacteria.⁶ It is the most common cause of vaginal discharge worldwide. However, in a nationally representative survey, the majority of women with BV were asymptomatic.

Bacterial vaginosis is associated with having multiple male sex partners, female partners, sexual relationships with more than one person, a new sex partner, lack of condom use, douching and HSV-2 (herpes simplex virus 2) seropositivity.⁶ Prevalence increases during menses. Women who have never been sexually active are rarely affected.

BV is associated with pelvic inflammatory disease, which can harm a woman's reproductive organs and cause infertility.⁷ It also increases a woman's risk of preterm labor and preterm birth. (Preterm infants may face health challenges, including low birth weight and breathing problems.) However, treating BV in women who are pregnant has not been found consistently to reduce rates of preterm birth.

Bacterial vaginosis also increases a woman's risk of getting other sexually transmitted diseases, including HIV, if she is exposed to the pathogens that cause them.⁷For that reason, women with BV are advised to be tested for HIV and other sexually transmitted infections.⁵

Trichomoniasis

Trichomoniasis – another cause of vaginitis -- is estimated to be the most prevalent nonviral sexually transmitted infection worldwide.⁸ The U.S. population-based T. vaginalis prevalence is 2.1% among females and 0.5% among males, with the highest rates among Black females (9.6%) and Black males (3.6%), compared with non-Hispanic White women (0.8%) and Hispanic women (1.4%).

Most people who have trichomoniasis (70% to 85%) either have minimal or no genital symptoms, and untreated infections can last from months to years.⁸ Men with trichomoniasis sometimes have symptoms of urethritis, epididymitis, or prostatitis; and women with trichomoniasis sometimes have vaginal discharge, which can be diffuse, malodorous, or yellow-green with or without vulvar irritation. They might have a strawberry-appearing cervix, which is observed more often on colposcopy than on physical examination. Although many persons might be unaware of their infection, it is readily passed between sex partners during penile-vaginal sex or through transmission of infected vaginal fluids or fomites among women who have sex with women.

vaginalis has been associated with a 1.4 times greater likelihood of preterm birth, premature rupture of membranes, and infants who are small for gestational age.⁸ It has also been associated with a 2.1-fold increased risk for cervical cancer. Up to 53% of women with HIV have T. vaginalis infection. Because of the potential for adverse reproductive health, poor birth outcomes and possibly amplified HIV transmission, routine screening and prompt treatment are recommended for all women with HIV infection.

Most people who have trichomoniasis (70% to 85%) either have minimal or no genital symptoms, and untreated infections can last from months to years.

Diagnostic testing for T. vaginalis should be performed for women seeking care for vaginal discharge. Annual screening might be considered for persons receiving care in high-prevalence settings (e.g., STD clinics and correctional facilities) and for asymptomatic women at high risk for infection (e.g., those with multiple sex partners, transactional sex, drug misuse, or a history of STIs or incarceration.)⁸

Because of the high rate of reinfection among women treated for trichomoniasis, retesting for T. vaginalis is recommended for all sexually active women approximately three months after initial treatment regardless of whether they believe their sex partners were treated^.8. If retesting at three months is not possible, clinicians should retest whenever persons next seek medical care <12 months after initial treatment. Data are insufficient to support retesting men after treatment.

Consider this solution from SEKISUI Diagnostics

Obtaining a medical history by itself is insufficient for diagnosing vaginitis and can lead to inappropriate administration of medication. Careful examination and laboratory testing are necessary to determine the etiology of any vaginal symptoms.⁹But traditional laboratory methods such as Gram stain and culture may be highly subject to sampling, transport conditions, and technical proficiency, and may have prolonged turnaround times.²

Immediate vaginal health interventions can be accomplished at the first patient visit with CLIA-waived tests, such as OSOM® BVBlue Test and OSOM® Trichomonas Rapid Test from Sekisui Diagnostics. The tests offer quick (10-minute) turnaround time to results, high sensitivity and specificity, and minimal hands-on requirements. And because they are CLIA-waived, there is no need for equipment, specialized training or end-users with a specialized skill set.

To learn more about OSOM® products, go to osomtests.com

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