vulvovaginitis

Vulvovaginitis is a common gynecologic condition with infectious and non-infectious causes. Key infectious etiologies tested on boards include: (1) Candida vulvovaginitis - thick, white, 'cottage cheese' discharge, pruritus, normal vaginal pH (<4.5), risk factors include diabetes, antibiotic use, pregnancy, immunosuppression; diagnosed via KOH prep showing pseudohyphae; treated with topical or oral azoles (fluconazole). (2) Bacterial vaginosis - caused by overgrowth of anaerobes (Gardnerella vaginalis) with loss of Lactobacilli, thin grey-white discharge with fishy odor, elevated pH (>4.5), positive whiff test with KOH, clue cells on wet mount; treated with metronidazole or clindamycin; not classically an STI but associated with sexual activity. (3) Trichomoniasis - caused by Trichomonas vaginalis (flagellated protozoan, STI), frothy yellow-green discharge, strawberry cervix, motile trichomonads on wet mount, elevated pH; treated with metronidazole (treat partner too). Non-infectious causes include atrophic vaginitis in postmenopausal women (due to estrogen deficiency causing thinning of vaginal mucosa, dryness, dyspareunia), contact/irritant dermatitis from soaps/douches, and foreign bodies (especially in pediatric patients - consider retained toilet paper or foreign object with foul discharge/bleeding in children). In prepubertal girls, vulvovaginitis is often nonspecific, related to poor hygiene, or occasionally a sign of sexual abuse. Diagnosis relies on history, pH testing, microscopy (wet mount/KOH), and sometimes NAAT testing. This topic frequently appears on Step 1/Step 2 exams testing the ability to distinguish these entities based on classic discharge characteristics, pH, and microscopic findings.