Vaginits and STI’s

Vaginitis and STI’s

  • Topics covered: Vaginitis, STIs, HIV, UTIs, Testicular Disorders, Prostate Health.

Vaginitis and Sexually Transmitted Infections (STIs)

  • Vaginitis is one of the main complaints among women, commonly presenting as vaginal discharge.

  • Distinction between vaginal and testicular complaints: vaginal discharge is far more common.

Importance of Accurate Diagnosis

  • Misdiagnosis occurs frequently.

    • Many women incorrectly self-diagnose infections as yeast infections leading to inappropriate OTC treatments.

  • Laboratory documentation is crucial for identifying the specific organism causing the infection.

    • Infections can also arise from non-infectious etiologies, such as allergic reactions.

  • Empirical therapy may be warranted in the context of known exposure (e.g., chlamydia).

Laboratory Testing and Timing

  • Typical specimen collection turnaround: 36–48 hours; however, delays can occur (up to 72 hours noted).

  • Some clinics may perform point-of-care tests, but they are often expensive and underutilized.

  • Treatments differ based on the causative organism; hence identifying the exact cause is essential.

Factors Affecting Vaginitis Symptoms

  • Various infections contributing to vaginitis include:

    • Yeast infections

    • Bacterial vaginosis

    • Chlamydia

    • Gonorrhea

    • Trichomonas

  • Patient hygiene products (scented washes, douches) can exacerbate or contribute to infections.

  • Hormonal influences (estrogen, progesterone) affect vaginal discharge.

Clinical Evaluation of Vaginal Discharge

  • Important questions to assess:

    • Amount: How much discharge?

      • Little on underwear vs. needing pads.

    • Color / Odor: Is there an unusual color or smell?

    • Associated Symptoms: Burning, itching, lesions, pain during urination/intercourse.

  • Different phases of menstrual cycle can affect discharge characteristics (i.e., physiologic discharge).

  • Normal physiologic discharge: 1-4 mL over 24 hours, usually white or transparent, thick or thin, mostly odorless due to sloughing of epithelial cells from the uterus/vagina and bacteria.

Assessment of Symptoms

  • Differentiate acute vs. chronic symptoms. Acute likely infectious, while chronic may be inflammatory.

  • Noting treatment responses helps understand if infections are persistent or recurrent.

  • Presence of pelvic pain may indicate further assessment for pelvic inflammatory disease (PID).

Sexual History Assessment

  • Sensitive discussion about sexual practices is crucial for determining risk factors.

  • Consider implications of new sexual partners, especially within the past three months.

  • LGBTQ+ relationships, specifically women who have sex with women, show increased risk for vaginosis.

Diagnosis and Differential Diagnosis

  • Examination findings:

    • Normal vulva indicates absence of infection like bacterial vaginosis; erythema might suggest yeast or trichomon